Neumann U, Knoop M, Langrehr J M, Kaisers U, Bechstein W O, Blumhardt G, Lobeck H, Riess H, Neuhaus P
Chirurgische Klinik und Poliklinik, Klinikums Rudolf Virchow der Freien Universität Berlin.
Zentralbl Chir. 1995;120(6):478-81.
Patients with solid-organ transplantation are at risk for Graft-versus-host disease (GVHD) even though GVHD is a rare phenomenon after orthotopic liver transplantation (OLT).
The 30 yrs old male patient received an ABO compatible orthotopic liver graft for acute liver failure due to intoxication with amanita phalloides. Twenty-four days after OLT the patient developed high temperatures up to 40.0 degrees C and pancytopenia and was treated for CMV-infection. On postoperative day (POD) 32 an erythematous maculo-papular rash developed. A drug induced toxic epidermal necrolysis was suspected and treated with plasmapheresis for three days. Acute renal failure and respiratory insufficiency occurred while liver function was not impaired. A skin biopsy at that time showed no specific signs for GVHD. On POD 42 HLA-typing of circulating lymphocytes presented donor HLA phenotype and GVHD was established. Therapy with ATG was started but the clinical status of the patient did not improve. Following administration of OKT3 on POD 48 a reduction of activated CD-3 lymphocytes from 90% to 60% could be achieved. Due to the low platelet count the patient died of intracerebral hemorrhage on POD 52.
Since a fully developed GVHD is rare after OLT and the similarity of the clinical findings to viral or drug induced diseases is high, diagnosis is often made late in the course of the disease. Furthermore, therapeutic measures for GVHD are scarce and diagnosis has to be established as early as possible, hence pretransplant procurement of donor and recipient mononuclear cells for later study should be considered to decrease the time period between clinical suspicion and diagnosis.
实体器官移植患者有发生移植物抗宿主病（GVHD）的风险，尽管原位肝移植（OLT）后GVHD是一种罕见现象。
一名30岁男性患者因误食毒鹅膏导致急性肝衰竭，接受了ABO血型相容的原位肝移植。OLT术后24天，患者出现高达40.0摄氏度的高热和全血细胞减少，并接受了巨细胞病毒感染治疗。术后第32天出现红斑丘疹样皮疹。怀疑是药物性中毒性表皮坏死松解症，进行了三天的血浆置换治疗。虽然肝功能未受损，但出现了急性肾衰竭和呼吸功能不全。当时的皮肤活检未显示GVHD的特异性体征。术后第42天，循环淋巴细胞的HLA分型显示为供体HLA表型，确诊为GVHD。开始使用抗胸腺细胞球蛋白治疗，但患者的临床状况没有改善。术后第48天给予OKT3后，活化的CD-3淋巴细胞从90%降至60%。由于血小板计数低，患者于术后第52天死于脑出血。
由于OLT后完全发展的GVHD罕见，且临床发现与病毒或药物引起的疾病高度相似，诊断往往在疾病进程的后期做出。此外，针对GVHD的治疗措施很少，必须尽早确诊，因此应考虑在移植前采集供体和受体单核细胞用于后续研究，以缩短临床怀疑与诊断之间的时间间隔。
