留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肝移植术后患者自行停药致急性排斥反应(附3例报告)

李涛 申川 谢俊杰 祝哲诚 沈柏用 彭承宏

李涛, 申川, 谢俊杰, 等. 肝移植术后患者自行停药致急性排斥反应(附3例报告)[J]. 器官移植, 2014, 5(2): 100-102,122. doi: 10.3969/j.issn.1674-7445.2014.02.009
引用本文: 李涛, 申川, 谢俊杰, 等. 肝移植术后患者自行停药致急性排斥反应(附3例报告)[J]. 器官移植, 2014, 5(2): 100-102,122. doi: 10.3969/j.issn.1674-7445.2014.02.009
Li Tao, Shen Chuan, Xie Junjie, et al. Analysis of acute rejection caused by immunosuppressants self-withdrawal after liver transplantation in three cases[J]. ORGAN TRANSPLANTATION, 2014, 5(2): 100-102,122. doi: 10.3969/j.issn.1674-7445.2014.02.009
Citation: Li Tao, Shen Chuan, Xie Junjie, et al. Analysis of acute rejection caused by immunosuppressants self-withdrawal after liver transplantation in three cases[J]. ORGAN TRANSPLANTATION, 2014, 5(2): 100-102,122. doi: 10.3969/j.issn.1674-7445.2014.02.009

肝移植术后患者自行停药致急性排斥反应(附3例报告)

doi: 10.3969/j.issn.1674-7445.2014.02.009
详细信息
    通讯作者:

    祝哲诚,Email:zhuzhecheng@126.com

  • 中图分类号: R617

Analysis of acute rejection caused by immunosuppressants self-withdrawal after liver transplantation in three cases

  • 摘要:   目的   探讨肝移植术后患者自行停药致急性排斥反应(AR)的临床特点及治疗。   方法   回顾性分析2004年1月至2013年6月上海交通大学医学院附属瑞金医院肝移植中心收治肝移植术后因自行停药导致AR的3例患者的临床资料。   结果   3例患者均因自行停止服用免疫抑制剂出现肝功能异常而入院治疗,停药18~42 d,经肝穿刺组织病理学结果明确均为急性细胞性排斥反应。给予恢复使用免疫抑制剂的同时采用肾上腺皮质激素(激素)冲击治疗或兔抗人胸腺细胞免疫球蛋白治疗后改小剂量激素维持。2例患者经治疗后好转,另1例经抢救后无效死亡。   结论   肝移植术后自行停药易发生AR,后果严重,应加强对患者的宣传教育,提高其服药依从性。一旦发生AR,即给予恢复使用免疫抑制剂,同时采用激素冲击或抗体治疗。

     

  • 表  1  3例肝移植术后因自行停药导致AR患者的临床资料

    Table  1.   Clinical data of 3 patients with AR caused by immunosuppressants self-withdrawal after liver transplantation

    序号性别年龄
    (岁)
    自行停药
    时间(d)
    发病距肝移
    植时间(年)
    肝功能Child-
    Pugh评分(分)
    丙氨酸转氨酶(U/L)总胆红素(μmol/L)肝穿刺病理结果入院免疫抑制治疗方案抗排斥策略转归
    入院时治疗后入院时治疗后
    例15618481563517217中度ARFK506+MMF激素冲击治愈,肝功能恢复正常
    例26742311243178386412重度AR,可见肝细胞坏死FK506+MMF激素冲击死亡
    例34323592212425838重度AR初用FK506+MMF后换西罗莫司+小剂量FK506+MMF即复宁治疗后改
    小剂量激素维持
    肝功能恢复近正常,病理提示慢性排斥反应
    下载: 导出CSV
  • [1] Liu XQ, Hu ZQ, Pei YF, et al. Clinical operational tolerance in liver transplantation: state-of-the-art perspective and future prospects[J]. Hepatobiliary Pancreat Dis Int,2013,12(1):12-33. doi: 10.1016/S1499-3872(13)60002-8
    [2] Ashton-Chess J, Giral M, Brouard S, et al. Spontaneous operational tolerance after immunosuppressive drug withdrawal in clinical renal allotransplantation[J]. Transplantation,2007,84(10):1215-1219. doi: 10.1097/01.tp.0000290683.54937.1b
    [3] Orlando G, Hematti P, Stratta RJ, et al. Clinical operational tolerance after renal transplantation: current status and future challenges[J]. Ann Surg,2010,252(6):915-928. doi: 10.1097/SLA.0b013e3181f3efb0
    [4] Trotter JF, O'Grady J. Operational tolerance after liver transplantation: raising the bar or tripping up?[J]. Am J Transplant,2010,10(10):2193-2194. doi: 10.1111/ajt.2010.10.issue-10
    [5] Orlando G, Soker S, Wood K. Operational tolerance after liver transplantation[J]. J Hepatol,2009,50(6):1247-1257. doi: 10.1016/j.jhep.2009.03.006
    [6] Wu SL, Pan CE. Tolerance and chimerism and allogeneic bone marrow/stem cell transplantation in liver transplantation[J]. World J Gastroenterol,2013,19(36):5981-5987. doi: 10.3748/wjg.v19.i36.5981
    [7] Alexander SI, Smith N, Hu M, et al. Chimerism and tolerance in a recipient of a deceased-donor liver transplant[J]. N Engl J Med,2008,358(4):369-374. doi: 10.1056/NEJMoa0707255
    [8] Liu H, Bakthavatsalam R, Meng Z, et al. PD-L1 signal on liver dendritic cells is critical for Foxp3(+)CD4(+)CD25(+) Treg and liver tolerance induction in mice[J]. Transplant Proc,2013,45(5):1853-1855. doi: 10.1016/j.transproceed.2013.03.015
    [9] Schulz-Juergensen S, Marischen L, Wesch D, et al. Markers of operational immune tolerance after pediatric liver transplantation in patients under immunosuppression[J]. Pediatr Transplant,2013,17(4):348-354. doi: 10.1111/petr.2013.17.issue-4
    [10] Ezzelarab M, Thomson AW. Tolerogenic dendritic cells and their role in transplantation[J]. Semin Immunol,2011,23(4):252-263. doi: 10.1016/j.smim.2011.06.007
    [11] Li L, Wozniak LJ, Rodder S, et al. A common peripheral blood gene set for diagnosis of operational tolerance in pediatric and adult liver transplantation[J]. Am J Transplant,2012,12(5):1218-1228. doi: 10.1111/j.1600-6143.2011.03928.x
    [12] Bohne F, Martínez-Llordella M, Lozano JJ, et al. Intra-graft expression of genes involved in iron homeostasis predicts the development of operational tolerance in human liver transplantation[J]. J Clin Invest,2012,122(1):368-382. doi: 10.1172/JCI59411
    [13] Shin M, Song S, Moon HH, et al. Characteristics of recipients who achieved spontaneous operational tolerance in adult liver transplantation[J]. Transplant Proc,2013,45(8):3024-3027. doi: 10.1016/j.transproceed.2013.08.015
    [14] Talisetti A, Hurwitz M, Sarwal M, et al. Analysis of clinical variables associated with tolerance in pediatric liver transplant recipients[J]. Pediatr Transplant,2010,14(8):976-979. doi: 10.1111/petr.2010.14.issue-8
    [15] Ohe H, Waki K, Yoshitomi M, et al. Factors affecting operational tolerance after pediatric living-donor liver transplantation: impact of early post-transplant events and HLA match[J]. Transpl Int,2012,25(1):97-106. doi: 10.1111/tri.2011.25.issue-1
    [16] Sánchez-Fueyo A. Hot-topic debate on tolerance: immunosuppression withdrawal[J]. Liver Transpl,2011,17(Suppl 3):S69-S73. http://cn.bing.com/academic/profile?id=1997897305&encoded=0&v=paper_preview&mkt=zh-cn
    [17] Banff Working Group on Liver Allograft Pathology. Importance of liver biopsy findings in immunosuppression management: biopsy monitoring and working criteria for patients with operational tolerance[J]. Liver Transpl,2012,18(10):1154-1170. doi: 10.1002/lt.v18.10
  • 加载中
表(1)
计量
  • 文章访问数:  286
  • HTML全文浏览量:  208
  • PDF下载量:  11
  • 被引次数: 0
出版历程
  • 收稿日期:  2013-12-29
  • 网络出版日期:  2021-01-26
  • 刊出日期:  2014-03-15

目录

    /

    返回文章
    返回