Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
Institute of Biostatistics and Clinical Research, University Münster, Münster, Germany.
Hepatol Commun. 2023 Sep 27;7(10). doi: 10.1097/HC9.0000000000000260. eCollection 2023 Oct 1.
Graft-versus-host disease following liver transplantation is a serious and usually fatal complication. Data identifying the risk factors and specifying the diagnosis and treatment options of the disease are scarce and contentious. Moreover, recommendations for therapeutic approaches are similarly sparse.
A systematic review of the literature from 1988 to 2020 on graft-versus-host disease following liver transplantation was performed using the PubMed and MEDLINE databases. Medical subject headings, such as graft-versus-host disease and GvHD were used in combination with solid organ transplant, transplantation, or liver transplant. Following duplicate removal, 9298 articles were screened for suitability. A total of 238 full-text articles were analyzed for eligibility, resulting in 130 eligible articles for meta-analysis. Two hundred twenty-five patients developing graft-versus-host disease following liver transplantation reported herein were mainly published in case reports and case series.
Graft-versus-host disease occurred with an incidence of 1.2%. 85% developed following deceased donor liver transplant and 15% following living-related donor liver transplantation. The median follow-up period following liver transplantation was 84 days (interquartile range, 45-180). The median time from liver transplantation to graft-versus-host disease onset was 30 days (interquartile range, 21-42). The main clinical features included skin rash (59%), fever (43%), diarrhea (36%), and pancytopenia (30%). The overall mortality rate was 71%. Neither univariate (HR = 0.999; 95% CI, 0.493-2.023; p = 1.0) nor multivariate Cox regression analysis revealed a significant correlation between adaptation of immunosuppression and survival probability (HR = 1.475; 95% CI, 0.659-3.303; p = 0.3).
This systematic review suggests that an increase in immunosuppressive regimen does not yield any survival benefit in patients suffering from graft-versus-host disease following liver transplantation.
肝移植后移植物抗宿主病是一种严重且通常致命的并发症。目前关于该病的风险因素、诊断和治疗选择的数据有限且存在争议。此外，关于治疗方法的建议也同样缺乏。
我们对 1988 年至 2020 年间发表的关于肝移植后移植物抗宿主病的文献进行了系统评价，检索了 PubMed 和 MEDLINE 数据库。使用了“移植物抗宿主病”和“GvHD”等医学主题词，并结合了实体器官移植、移植或肝移植。在重复去除后，筛选了 9298 篇文章以确定其适宜性。总共分析了 238 篇全文文章以确定其纳入标准，其中 130 篇符合条件的文章纳入荟萃分析。本研究报告了 225 例肝移植后发生移植物抗宿主病的患者，主要来源于病例报告和病例系列。
移植物抗宿主病的发生率为 1.2%。85%发生于已故供体肝移植后，15%发生于活体亲属供体肝移植后。肝移植后中位随访时间为 84 天（四分位距，45-180）。肝移植至移植物抗宿主病发病的中位时间为 30 天（四分位距，21-42）。主要临床特征包括皮疹（59%）、发热（43%）、腹泻（36%）和全血细胞减少（30%）。总体死亡率为 71%。单因素（HR = 0.999；95%CI，0.493-2.023；p = 1.0）和多因素 Cox 回归分析均未显示免疫抑制适应与生存概率之间存在显著相关性（HR = 1.475；95%CI，0.659-3.303；p = 0.3）。
本系统评价提示，肝移植后移植物抗宿主病患者增加免疫抑制方案并不能带来生存获益。
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