Department of Medicine, 6221Western University, London, ON, Canada.
Division of Hematology, Department of Medicine, 6221Western University, London, ON, Canada.
Sci Prog. 2022 Jul-Sep;105(3):368504221117070. doi: 10.1177/00368504221117070.
Graft versus host disease is a rare but deadly complication of solid organ transplant. Clinical features of graft-versus-host-disease are non-specific, which may lead to delayed diagnosis as more common conditions including infections or drug reactions are considered. We describe a 54-year-old male patient who underwent liver transplantation for alcohol use disorder-related cirrhosis and developed acute graft-versus-host disease. Initial clinical presentation included dermatitis, bone marrow failure and enteritis. Results of skin biopsy and cytogenetic studies were consistent with liver transplant-associated acute graft-versus-host disease. The importance of this case is to highlight to transplant physicians and surgeons the challenges of diagnosing graft-versus-host-disease. In our case, pre-existing partnerships among the liver and hematopoietic stem cell transplant teams, transfusion medicine specialists, critical care specialists and facilitated timely communication relevant to confirming graft-versus-host disease. We propose an algorithm to assist in the workup of suspected graft-versus-host disease. Because this condition is characterized by high mortality, a high index of suspicion is imperative for prompt diagnosis and optimal management of the donor-recipient immune interaction when patients present with classic clinical features.
移植物抗宿主病是实体器官移植的一种罕见但致命的并发症。移植物抗宿主病的临床特征是非特异性的，这可能导致诊断延迟，因为更常见的情况，包括感染或药物反应，被认为是。我们描述了一位 54 岁的男性患者，因酒精使用障碍相关肝硬化接受了肝移植，并发生了急性移植物抗宿主病。最初的临床表现包括皮炎、骨髓衰竭和肠炎。皮肤活检和细胞遗传学研究的结果与肝移植相关的急性移植物抗宿主病一致。这个病例的重要性在于向移植医生和外科医生强调诊断移植物抗宿主病的挑战。在我们的病例中，肝和造血干细胞移植团队、输血医学专家、重症监护专家之间预先存在的伙伴关系，并促进了及时沟通，有助于确认移植物抗宿主病。我们提出了一个算法来协助疑似移植物抗宿主病的检查。由于这种情况的死亡率很高，当患者出现典型的临床特征时，必须高度怀疑该病，以便及时诊断和优化供体-受者免疫相互作用的管理。
