程序性死亡受体(PD)-1单克隆抗体治疗肝癌肝移植术后复发诱发急性免疫性肝炎:附1例报告

汪国营; 唐晖; 张英才; 李华; 易述红; 姜楠; 汪根树; 张剑; 张琪; 杨扬; 陈规划

doi:10.3969/j.issn.1674-7445.2016.01.008

程序性死亡受体(PD)-1单克隆抗体治疗肝癌肝移植术后复发诱发急性免疫性肝炎:附1例报告

doi: 10.3969/j.issn.1674-7445.2016.01.008

510630 广州, 中山大学附属第三医院肝脏外科暨肝移植中心广东省器官移植研究中心中山大学器官移植研究所

基金项目:

国家十二五科技重大专项 2012ZX10002017-005

国家十二五科技重大专项 2012ZX10002016-023

广东省科技计划项目 2014A020211015

广东省自然科学基金 2015A030313038

广州市科技计划项目 201400000001-3

广州市科技计划项目 2014J4100183

详细信息

通讯作者:
陈规划,Email:chgh1955@263.net

中图分类号: R617;R575.1
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- 被引次数: 0
出版历程
- 收稿日期: 2015-10-16
- 网络出版日期: 2021-01-19
- 刊出日期: 2016-01-15

Programmed death receptor(PD)-1 monoclonal antibody-induced acute immune hepatitis in the treatment of recurrent hepatocellular carcinoma after liver transplantation: a case report

Department of Hepatic Surgery, Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Transplantation Research Institute of Sun Yat-sen University, Guangzhou 510630, China

More Information

Corresponding author: Chen Guihua, Email: chgh1955@263.net

摘要

摘要: 目的探讨程序性死亡受体(PD)-1单克隆抗体治疗肝细胞癌(肝癌)肝移植术后复发的安全性。方法回顾性分析1例因使用PD-1单克隆抗体(pembrolizumab)治疗肝癌肝移植后复发而诱发急性免疫性肝炎患者的临床资料。结果患者因原发性肝癌行肝移植术,术后4个月发现肝癌肺转移,术后12个月予pembrolizumab治疗(150 mg静脉滴注1次),治疗后第5日发现肝功能异常,行肝穿刺活组织检查病理提示轻至中度急性排斥反应。结合患者临床表现、实验室检查以及pembrolizumab的药物说明书,诊断为急性免疫性肝炎。给予肾上腺皮质激素及加强免疫抑制治疗,随访8个月患者带瘤生存,但肝功能仍持续异常。结论肝移植术后免疫抑制状态下不宜应用PD-1单克隆抗体等免疫检查点抑制剂,有诱发免疫性肝炎的风险。
- 肝移植 /
- 免疫性肝炎 /
- 程序性死亡受体 /
- 程序性死亡受体-1单克隆抗体 /
- 不良反应
Abstract: Objective To explore the safety of programmed death receptor (PD)-1 monoclonal antibody for treatment of hepatocellular carcinoma (HCC) recurrence after liver transplantation. Methods Clinical data of 1 case with acute immune hepatitis induced by PD-1 monoclonal antibody(pembrolizumab) therapy for recurrent HCC after liver transplantation was retrospectively analyzed. Results The patient who received liver transplantation for primary HCC was diagnosed with lung metastasis at 4 months after the transplantation, and treated with the pembrolizumab (150 mg intravenous infusion of once) at 12 months after transplantation. Liver dysfunction was found at 5^th d after treatment, and liver biopsy was conducted which showed pathological changes of mild to moderate acute rejection. It was diagnosed to be acute immune hepatitis based on the patient's clinical manifestations, laboratory examination and pembrolizumab drug instructions. After adrenal cortical hormone and intensive immunosuppressive therapy, the patient was followed up for 8 months, which showed that the patient survived with tumor, but the liver function remained abnormal. Conclusions PD-1 monoclonal antibody and other immune checkpoint inhibitors are not suitable for the immunologic suppression after liver transplantation due to the risk of inducing immune hepatitis.
- Liver transplantation /
- Immune hepatitis /
- Programmed death receptor-1 monoclonal antibody /
- Adverse reaction /

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图 1 本例患者病理学及影像学检查结果

注：A图为肝穿刺活组织检查的肝组织切片(苏木素-伊红，×400)；B图和C图为胸部CT显示肺部转移瘤；D图为MRCP显示胆管吻合口狭窄

Figure 1. Results of pathological and imaging examinations of the patient

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