Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia.
Alazizyah Children Hospital, Jeddah, Saudi Arabia.
Pediatr Transplant. 2022 Dec;26(8):e14381. doi: 10.1111/petr.14381. Epub 2022 Aug 18.
GVHD is a well-documented complication after liver transplantation. GVHD occurs when donor immune cells mount a destructive immune response against host cells. The rarity of the GVHD complication and the nonspecific presentation of symptoms and histopathological features provide a diagnostic challenge. Therefore, diagnosis and initiation of treatment are often delayed.
In this systematic review, we assessed relevant literature to better understand the utilization of HLA typing and chimerism analysis in liver transplantation. We mainly focused on their importance in diagnosing GVHD incidence after liver transplantation.
A total of 18 articles reported 21 cases of GVHD after liver transplantation in pediatrics. Generally, there is a consensus on the advantage of HLA typing and chimerism analysis in confirming the diagnosis of GVHD after liver transplantation. However, there is an inconsistency in the timing and the application of the accurate HLA typing and chimerism analysis.
Further studies are required to assess the incidence of GVHD post-LT and to determine the impact of HLA typing and chimerism analysis in assessing the risk, early determination of GVHD incidence, and improving outcomes. This systematic review highlights the gap in the field of liver transplantation and calls for revisiting the guidelines to consider HLA typing and chimerism analysis in predicting GVHD before transplantation and diagnosing GVHD incidence after liver transplantation.
GVHD 是肝移植后的一种已被充分记录的并发症。当供体免疫细胞对宿主细胞发起破坏性免疫反应时，就会发生 GVHD。GVHD 并发症的罕见性以及症状和组织病理学特征的非特异性表现，给诊断带来了挑战。因此，诊断和治疗的启动常常会被延误。
在本系统评价中，我们评估了相关文献，以更好地了解 HLA 分型和嵌合体分析在肝移植中的应用。我们主要关注它们在诊断肝移植后 GVHD 发生率方面的重要性。
共有 18 篇文章报道了儿科肝移植后 21 例 GVHD。通常，HLA 分型和嵌合体分析在确认肝移植后 GVHD 诊断方面的优势已达成共识。然而，在准确的 HLA 分型和嵌合体分析的时机和应用方面存在不一致。
需要进一步研究来评估肝移植后 GVHD 的发生率，并确定 HLA 分型和嵌合体分析在评估风险、早期确定 GVHD 发生率以及改善结局方面的作用。本系统评价强调了肝移植领域的空白，并呼吁重新审视指南，在移植前考虑 HLA 分型和嵌合体分析来预测 GVHD，并在肝移植后诊断 GVHD 发生率。
