Diagnosis and treatment of acute graft-versus-host disease after liver transplantation:Report of six cases  

作　　者：Min Tian Yi Lyu Bo Wang Chang Liu Liang Yu Jian-Hua Shi Xue-Min Liu Xiao-Gang Zhang Kun Guo Yu Li Liang-Shuo Hu 

机构地区：[1]Department of Hepatobiliary Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,Shaanxi Province,China

出　　处：《World Journal of Clinical Cases》2021年第30期9255-9268,共14页世界临床病例杂志

基　　金：Supported by The National Natural Science Foundation of China,No.81870445;Scientific Research Project of Military Healthcare,No.BZZ19J004.

摘　　要：BACKGROUND Graft-versus-host disease(GVHD)following liver transplantation(LT)is an unpredictable complication with poor outcome.However,consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking.The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD(aGVHD)following LT and reviewed the pertinent literature.CASE SUMMARY Between January 1^(st),2000 and December 31^(st),2020,a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University.Six recipients developed aGVHD with clinical symptoms of fever,rash,diarrhea,and pancytopenia.The incidence of aGVHD was 0.57%.The median time from LT to the clinical presentation of aGVHD was 22.17 d.The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d.All six cases underwent treatment of immunosuppressant adjustment,corticosteroids,human normal immunoglobulin,and antithymocyte globulin/IL-2 antagonists.Despite intensive treatment strategies,4 patients were deceased due to sepsis,multiple organ failure,and cerebral hemorrhage.The remaining two cases were discharged as treatment successfully.However,one died because of tuberculosis infection on the 6 th month of follow-up,the other one was alive healthy during 30 mo of follow-up.CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom,histopathological features,and the donor T-lymphocyte chimerism.Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD.Moreover,gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.

关 键 词：Graft-versus-host disease Liver transplantation Donor T-lymphocytes chimerism Gut microbiota Donor-targeted serotherapy Case report 

分 类 号：R657.3[医药卫生—外科学]