Abstract:

Objective To investigate the etiology，diagnosis and treatment of graft-versus-host diseaseafter liver transplantation. Methods Progression，histology，diagnosis and treatment of one suspected case of GVHD after liver transplantation were analyzed and correlative literatures were reviewed. Results The patient suffered fever，epilepsy，rashes and hematopoietic stagnation 2 weeks after liver transplantation and had no response to anti-infection therapy. Considering of clinical symptoms together with the histological appearance of skin lesions，blood and bone marrow cytology tests，and T-cell subsets，GVHD was suspected. Immunosuppressants were discontinued and high-dose steroid therapy with 1 000 mg/day intravenous methylprednisolone was administered. Skin rashes faded，but the general condition deteriorated and the patient died of multiple organ failure 3 weeks afterliver transplantation Conclusion GVHD is a rare and life threatening complication after liver transplantation withmortality ＞ 75%. There is no standard diagnosis criterion. We summarize this suspected case and review literatures about GVHD after liver transplantation in order to increase awareness of the disease.

摘要：

目的 探讨肝移植术后移植物抗宿主病（GVHD）的病因、诊断及治疗。方法 回顾性分析天津市第一中心医院 1 例肝移植术后疑诊 GVHD 患者的病情进展、组织学特点及治疗经过，并进行相关文献复习。结果 患者于外院行肝移植术，术后 2 周先后出现发热、癫痫、皮疹、骨髓造血停滞等症状，经抗感染治疗无效，病史结合皮肤活检、骨髓涂片镜检、T 细胞亚群等检查，考虑 GVHD，停用免疫抑制剂，甲泼尼龙 1 g 静脉滴注，皮疹消褪，但整体病情进展，于术后 3 周患者死于多器官功能衰竭。结论 肝移植术后 GVHD 为一种致命的并发症，病死率高达 75% 以上，目前尚无确诊标准，本文结合该病例特点，复习肝移植术后 GVHD 相关文献，并提出待解决问题，以期提高对该疾病的认识，并指导临床工作。