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Abstract:

Objective To analyze the clinical characteristics and treatment of graft-versus-host disease（GVHD）after renal transplantation，and to explore the diagnosis and treatment of GVHD after renal transplantation. Methods A rare case of GVHD after renal transplantation in our hospital was retrospectively analyzed. The patient was admitted to hospital 25 days after kidney transplantation because of skin damage，fever，hematemesis and blackstool. He was highly suspicious of GVHD. In orderto make a definite diagnosis，skin biopsy was performed at the lesion. Immunosuppressive agents were discontinued and low dose methylprednisolone was given. Immunoglobulin combined with thymosin enhanced immunity and anti-infection. Nutritional support，colony stimulating factor，plasma transfusion，platelet transfusion，skin care and continuous bedside ultrafiltration were given for leukopenia and thrombocytopenia.Results Pathological report of skin biopsy showed that the basal layer cells of skin epidermis had vacuolardegeneration，eosinophilic necrosis in epidermis，infiltrative GVHD changes of lymphocyte in dermis，combined with the clinical symptoms of patients，GVHD after kidney transplantation was diagnosed. After the above treatment，the patient's condition once improved，and the treatment program played a certain role. But the patient eventually died of hemorrhagic shock and multiple organ failure. Conclusion GVHD is extremely rare in kidney transplantation patients，its clinical manifestations are atypical，which leads to delayed diagnosis，rapid progression of GVHDand poor prognosis. In clinical work，when the patients have fever，rash，diarrhea and bone marrow depression ofunknown causes after transplantation，GVHD should be highly suspected. Skin biopsy is a feasible method to diagnoseGVHD. At the same time，low dose methylprednisolone bolus therapy should be given. Immunoglobulin combined with thymosin can enhance immunity. Drug therapy such as Li may benefit more.

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