肝移植后早期发生的慢性排斥反应

IF 0.2 Q4 TRANSPLANTATION
Nalini Bansal, Arif Ali Khan, Manav Wadhawan, Vivek Vij
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引用次数: 0

摘要

我们报告一个36岁的男性病例,他被转到我们的临时诊断为酒精相关的急性慢性肝衰竭,伴有腹水、脑病和肝功能检查(LFTs)改变。病人接受了活体肝脏移植手术。移植后,患者顺利恢复,直到术后第7天出现心动过速和低烧。免疫抑制需延迟至POD 26。患者后来发展为精神错乱的LFT,最初的肝活检显示急性细胞排斥反应的特征。他也有持续的心动过速;因此,免疫抑制被抑制。随后,患者在移植后78天内从早期进行性排斥反应迅速发展为慢性排斥反应(CR)。患者最初对抗胸腺细胞球蛋白有反应,但最终死于真菌感染。CR通常发生在移植后6个月以上。指数型患者很早就发现了CR的发生。本病例强调了肝移植后采用基本分步治疗方法的重要性。它还强调了专业肝脏组织病理学帮助早期诊断的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chronic Rejection Occurring Early Post Liver Transplant
We report the case of a 36-year-old male who was referred to us with a provisional diagnosis of ethanol-related acute on chronic liver failure with ascites, encephalopathy, and altered liver function tests (LFTs). The patient underwent a living donor liver transplant. Posttransplant, he had an uneventful recovery till postoperative day (POD) day 7 when he developed tachycardia and low-grade fever. The immunosuppression has to be withheld till POD 26. The patient later developed deranged LFT and an initial liver biopsy showed features of acute cellular rejection. He also had ongoing tachycardia; thus, immunosuppression was withheld. Subsequent to that patient developed rapid progression from progressive early to chronic rejection (CR) within 78 days posttransplant. The patient initially responded to antithymocyte globulin, but finally succumbed to fungal infection. CR usually occurs over 6 months posttransplant. The occurrence of CR was noted very early in the index patients. This case highlights the importance of a basic step-wise approach to a case post liver transplant. It also highlights the importance of specialized liver histopathology aiding in early diagnosis.
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来源期刊
Indian Journal of Transplantation
Indian Journal of Transplantation Medicine-Transplantation
CiteScore
0.40
自引率
33.30%
发文量
25
审稿时长
21 weeks
期刊介绍: Indian Journal of Transplantation, an official publication of Indian Society of Organ Transplantation (ISOT), is a peer-reviewed print + online quarterly national journal. The journal''s full text is available online at http://www.ijtonline.in. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. It has many articles which include original articIes, review articles, case reports etc and is very popular among the nephrologists, urologists and transplant surgeons alike. It has a very wide circulation among all the nephrologists, urologists, transplant surgeons and physicians iinvolved in kidney, heart, liver, lungs and pancreas transplantation.
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