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。%Objective To investigate the etiology,diagnosis and treatment of graft-versus-host disease after 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 stagnation2 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 with1000 mg/day intravenous methylprednisolone was administered. Skin rashes faded, but the general condition deteriorated and the patient died of multiple organ failure3 weeks after liver transplantationConclusion GVHD is a rare and life threatening complication after liver transplantation with mortality>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.
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