Cattral M S, Langnas A N, Markin R S, Antonson D L, Heffron T G, Fox I J, Sorrell M F, Shaw B W
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Hepatology. 1994 Oct;20(4 Pt 1):813-8. doi: 10.1002/hep.1840200407.
We determined the incidence and outcome of aplastic anemia among 56 patients who underwent liver transplantation for fulminant liver failure at the University of Nebraska Medical Center between July 1985 and December 1993. Aplastic anemia developed in 6 of 18 (33%) children and 1 of 19 (5%) adults who had fulminant non-A, non-B hepatitis; no cases of aplastic anemia occurred among patients with other causes of fulminant liver failure. None of these patients had evidence of a preexisting hematological disorder or infection with hepatitis C virus (as determined with a second-generation ELISA). Aplastic anemia was diagnosed at a median of 4 wk after the onset of hepatitis, with five cases seen before transplantation. Six patients received antithymocyte globulin to promote remission of aplastic anemia. Three children died (fungal infection in two, intracranial hemorrhage in one)--one at 43, one at 108 and one at 119 days after transplantation--without remission of aplastic anemia. Among the four surviving patients, with median follow-up of 25 mo, complete and partial remission of aplastic anemia have occurred in three and one, respectively. Liver allograft function is stable in all surviving patients. The data demonstrate that aplastic anemia is a common complication among children who undergo liver transplantation for fulminant non-A, non-B hepatitis. It is associated with a high rate of mortality, although most survivors appear to have full hematological recovery.
我们确定了1985年7月至1993年12月间在内布拉斯加大学医学中心因暴发性肝功能衰竭接受肝移植的56例患者中再生障碍性贫血的发病率和转归情况。在18例（33%）暴发性非甲非乙型肝炎儿童患者中有6例发生再生障碍性贫血，19例（5%）成人患者中有1例发生；暴发性肝功能衰竭的其他病因患者中未出现再生障碍性贫血病例。这些患者均无既往血液系统疾病证据或丙型肝炎病毒感染（通过第二代酶联免疫吸附测定确定）。再生障碍性贫血在肝炎发病后中位4周时被诊断，5例在移植前被发现。6例患者接受了抗胸腺细胞球蛋白治疗以促进再生障碍性贫血缓解。3例儿童死亡（2例死于真菌感染，1例死于颅内出血）——分别在移植后43天、108天和119天——再生障碍性贫血未缓解。在4例存活患者中，中位随访25个月，再生障碍性贫血完全缓解和部分缓解的分别有3例和1例。所有存活患者的肝移植功能均稳定。数据表明，再生障碍性贫血是因暴发性非甲非乙型肝炎接受肝移植儿童中的常见并发症。它与高死亡率相关，尽管大多数幸存者似乎血液学完全恢复。
