The Strategy Of Diagnosis And Treatment Of Graft-versus-host Disease After Liver Transplantation In 7 Cases

Objective:To summarize and analyze the clinical manifestations of graftversus-host disease(GVHD)after liver transplantation,and to explore the risk factors,diagnostic methods and treatment strategies of GVHD.Methods: A total of 290 cases of orthotopic liver transplantation were performed in the liver transplantation center of the First Hospital of Jilin University from October 2011 to January 2019,of which 6 cases developed GVHD after surgery.One case of GVHD developed after orthotopic liver transplantation in another hospital.After treatment,the symptoms showed no obvious improvement and was transferred to our center for further treatment.The clinical treatment and laboratory examination results of 7 patients were analyzed retrospectively.Clinical manifestations,skin biopsy,bone marrow puncture cytology,peripheral blood HLA match and chimera examination were used as the diagnostic basis.Immune-suppressing drugs were adjusted to combine high-dose hormone shock,immunoglobulin(IVIG)and bariximab as treatment.Results:About 2 weeks after surgery,7 patients began to show different degrees of symptoms,mainly including fever,rash,bone marrow suppression,and gastrointestinal symptoms.Among them,6 cases had fever of unknown causes,and 1 case had pathogen infection when fever occurred.After antiinfection treatment,other symptoms still appeared.All 7 patients had rash changes.Severe diarrhea occurred in 4 patients,and gastrointestinal bleeding occurred in 1 patient.Severe myelosuppression was found in 5 cases.The correlation with GVHD could not be determined in 2 patients with neuropsychiatric status changes.metaphase liver function is basically normal in the early and middle stages of the disease,all pathogens and imaging examinations were almost negative.Two cases were diagnosed by clinical manifestations,and the other five cases were diagnosed as GVHD by skin biopsy,bone marrow cytology,chimeric detection and peripheral blood HLA.The treatment was successful in 3 patients,one of them reached the status of immune tolerance and had stopped using immunosuppressive agents completely.The 3 patients have survived for 5 years,3 years and 6 months,respectively.Among the 4 cases of death,all of them were associated with severe myelosuppression,resulting in a significant reduction of the three systems: One case died of cerebral hernia due to increased intracranial pressure caused by massive cerebral infarction.One case died of respiratory failure due to severe pulmonary infection.One case died of gastrointestinal bleeding.One patient died of multiple organ failure.Conclusion:The incidence of GVHD after liver transplantation is low,and the clinical manifestations have no obvious specificity.Early diagnosis is difficult and the rate of misdiagnosis is high.Even timely intervention can result in higher mortality due to severe myelosuppression.With the withdrawal of immunosuppressive agents and the combination of high-dose hormone shock,immunoglobulin(IVIG)and baliximab as the treatment means,relatively significant therapeutic effects have been achieved.