Pageaux G P, Perrigault P F, Fabre J M, Portales P, Souche B, Dereure O, Eliaou J F, Larrey D, Domergue J, Michel H
Service d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, Montpellier, France.
Clin Transplant. 1995 Feb;9(1):65-9.
We report herein the case of a patient who developed fatal acute graft-versus host disease (GvHD) after liver transplantation (LT). GvHD occurred 18 days after LT and was characterized by skin epidermolysis, diarrhea and leucopenia. Skin biopsy showed epidermal dyskeratosis with epithelial necrosis, a lesion consistent with GvHD. Despite immunosuppressive therapy, the patient died within 24 days. In our observation, GvHD occurred although five HLA compatibilities were identified between the donor and the recipient, an apparently favorable and uncommon situation. This case further supports the qualification that LT may be complicated by GvHD and strongly suggests that minor rather than major histocompatibility antigens are the main target of allogenic interactions of GvHD. The involvement of chimerism in GvHD is controversial and requires further investigation.
我们在此报告一例肝移植（LT）后发生致命性急性移植物抗宿主病（GvHD）的患者。GvHD发生在LT后18天，其特征为皮肤表皮松解、腹泻和白细胞减少。皮肤活检显示表皮发育异常伴上皮坏死，这一病变与GvHD相符。尽管进行了免疫抑制治疗，患者仍在24天内死亡。在我们的观察中，尽管供体和受体之间确定了5个HLA相容性，这是一种明显有利且不常见的情况，但仍发生了GvHD。该病例进一步支持了LT可能并发GvHD这一观点，并强烈提示次要而非主要组织相容性抗原是GvHD同种异体相互作用的主要靶点。嵌合体在GvHD中的作用存在争议，需要进一步研究。
