Hägglund H, Winiarski J, Ringdén O, Sparrelid E, Ericzon B G
Department of Transplantation Surgery, Huddinge Hospital, Karolinska Institute, Sweden.
Transplantation. 1997 Oct 27;64(8):1207-8. doi: 10.1097/00007890-199710270-00023.
A 2.5-year-old boy received a cadaveric orthotopic liver transplant for acute liver failure due to non-A, non-B, non-C hepatitis. After transplantation, he developed thrombocytopenia and neutropenia and subsequently severe aplastic anemia. The patient also suffered from recurrent cytomegalovirus (CMV) viremia, treated with foscarnet and ganciclovir.
For treatment of his aplastic anemia, the patient underwent an allogeneic bone marrow transplantation from his HLA-identical sister after conditioning with cyclophosphamide at 200 mg/kg and antithymocyte globulin at 3 mg/kg for 5 days. Prophylactic acyclovir was given because of ongoing CMV viremia at the time of bone marrow transplantation.
The transplant course was uneventful, with rapid engraftment. There were no signs of liver dysfunction, graft-versus-host disease, or reactivation of CMV. The patient is in excellent health, with normal liver and bone marrow function 3 years after bone marrow transplantation.
This case report shows that allogeneic bone marrow transplantation is feasible and well tolerated in a patient with severe aplastic anemia after liver transplantation for acute fulminant viral hepatitis.
一名2.5岁男孩因非甲、非乙、非丙型肝炎导致急性肝衰竭接受了尸体原位肝移植。移植后，他出现了血小板减少和中性粒细胞减少，随后发展为严重再生障碍性贫血。该患者还患有复发性巨细胞病毒（CMV）病毒血症，接受了膦甲酸钠和更昔洛韦治疗。
为治疗其再生障碍性贫血，患者在接受200mg/kg环磷酰胺和3mg/kg抗胸腺细胞球蛋白预处理5天后，接受了来自其 HLA 相同姐姐的异基因骨髓移植。由于骨髓移植时CMV病毒血症仍在持续，给予了预防性阿昔洛韦。
移植过程顺利，造血迅速恢复。没有肝功能障碍、移植物抗宿主病或CMV重新激活的迹象。骨髓移植3年后，患者健康状况良好，肝脏和骨髓功能正常。
本病例报告表明，对于急性暴发性病毒性肝炎肝移植后发生严重再生障碍性贫血的患者，异基因骨髓移植是可行的，且耐受性良好。
