PDF(Pubmed)
Abstract：
Graft versus host disease is a rare but deadly complication of solid organ transplant. Clinical features of graft-versus-host-disease are non-specific, which may lead to delayed diagnosis as more common conditions including infections or drug reactions are considered. We describe a 54-year-old male patient who underwent liver transplantation for alcohol use disorder-related cirrhosis and developed acute graft-versus-host disease. Initial clinical presentation included dermatitis, bone marrow failure and enteritis. Results of skin biopsy and cytogenetic studies were consistent with liver transplant-associated acute graft-versus-host disease. The importance of this case is to highlight to transplant physicians and surgeons the challenges of diagnosing graft-versus-host-disease. In our case, pre-existing partnerships among the liver and hematopoietic stem cell transplant teams, transfusion medicine specialists, critical care specialists and facilitated timely communication relevant to confirming graft-versus-host disease. We propose an algorithm to assist in the workup of suspected graft-versus-host disease. Because this condition is characterized by high mortality, a high index of suspicion is imperative for prompt diagnosis and optimal management of the donor-recipient immune interaction when patients present with classic clinical features.
摘要：
移植物抗宿主病是实体器官移植的一种罕见但致命的并发症。移植物抗宿主病的临床特征是非特异性的，这可能导致延迟诊断，因为考虑了更常见的疾病，包括感染或药物反应。我们描述了一名54岁的男性患者，他因酒精使用障碍相关的肝硬化接受了肝移植，并发展为急性移植物抗宿主病。最初的临床表现包括皮炎，骨髓衰竭和肠炎。皮肤活检和细胞遗传学研究的结果与肝移植相关的急性移植物抗宿主病一致。这种情况的重要性是向移植医师和外科医生强调诊断移植物抗宿主病的挑战。在我们的案例中,肝脏和造血干细胞移植团队之间预先存在的伙伴关系，输血医学专家,重症监护专家，并促进与确认移植物抗宿主病相关的及时沟通。我们提出了一种算法来协助可疑的移植物抗宿主病的检查。因为这种情况的特点是死亡率高，当患者具有经典临床特征时,高度怀疑指数对于及时诊断和优化供体-受体免疫相互作用的管理至关重要.
