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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 doi: 10.3877/cma.j.issn.2095-3232.2024992

指南与共识

肝移植术后急性移植物抗宿主病诊疗中国专家共识（2024版）
中华医学会器官移植学分会, 中国医师协会器官移植医师分会   
  1. 1. 吉林大学第一医院，长春　130021
    2. 上海复旦大学附属中山医院，上海　200032
    3. 杭州医学院附属人民医院，杭州　310014
    4. 中山大学附属第三医院，广州　510630
    5. 首都医科大学附属北京友谊医院，北京　100050
  • 收稿日期:2024-07-31
  • 基金资助:
    国家自然科学基金(82241223，U20A20360)

Chinese expert consensus on the diagnosis and treatment of acute graft-versus-host disease after liver transplantation (2024 edition)

Branch of Organ Transplant of China Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association   

  1. 1. First Hospital of Jilin University, Changchun 130021, China
    2. Zhongshan Hospital, Fudan University, Shanghai 200032, China
    3. People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
    4. The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    5. Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2024-07-31
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引用本文：

中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 肝移植术后急性移植物抗宿主病诊疗中国专家共识（2024版）[J]. 中华肝脏外科手术学电子杂志, doi: 10.3877/cma.j.issn.2095-3232.2024992.

Branch of Organ Transplant of China Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Chinese expert consensus on the diagnosis and treatment of acute graft-versus-host disease after liver transplantation (2024 edition)[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), doi: 10.3877/cma.j.issn.2095-3232.2024992.

肝移植术后移植物抗宿主病（GVHD）是一种罕见但致命的并发症，发病率<1%，病死率高达85%。GVHD的发生是因供者T淋巴细胞对受者组织产生的细胞免疫反应，可累及皮肤、胃肠道和骨髓，典型临床表现包括皮疹、发热、腹泻和全血细胞减少。中华医学会器官移植学分会和中国医师协会器官移植医师分会组织行业内专家制订《肝移植术后急性移植物抗宿主病诊疗中国专家共识（2024版）》，对GVHD的发病机制、危险因素、临床表现、诊断及治疗进行详细阐述，旨在规范与优化肝移植术后GVHD的临床诊断与治疗，并提出诊断流程和治疗建议，以期改善肝移植术后GVHD受者预后。

关键词: 肝移植, 急性移植物抗宿主病, 诊断, 治疗, 共识

Graft-versus-host disease (GVHD) after liver transplantation is a rare but fatal complication, with the incidence rate < 1% and mortality of 85%. The occurrence of GVHD is due to the cellular immune response of donor T lymphocytes to recipient tissues, which can affect the skin, gastrointestinal tract, and bone marrow. The typical clinical manifestations of GVHD include rash, fever, diarrhea, and decreased whole blood cells. The Branch of Organ Transplant of China Medical Association, combined with Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to develop the Chinese Expert Consensus On The Diagnosis And Treatment Of Acute Graft-Versus-Host Disease After Liver Transplantation (2024 edition), which elaborates on the pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of GVHD. The aim is to standardize and optimize the clinical diagnosis and treatment of GVHD after liver transplantation, and to propose diagnostic processes and treatment suggestions to improve the prognosis of GVHD recipients after liver transplantation.

Key words: Liver transplantation, Acute graft-versus-host disease, Diagnosis, Treatment, Consensus
表1 推荐分级的评估、制订与评价网格
项目 等级分数（分）
2 1 0 -1 -2
干预措施的利弊权衡 明显利大于弊 可能利大于弊 利弊相当或不确定 可能弊大于利 明显弊大于利
推荐强度 强推荐 弱推荐 无明确 弱不推荐 强不推荐
表2 证据等级标准
证据等级 内容
1a 随机对照试验的系统综述（同质性）
1b 单个随机对照试验
1c "全或无"的病例系列研究
2a 队列研究的系统评价（同质性）
2b 单个队列研究，包括低治疗的随机对照研究，如随访率<80%
3a 病例对照研究的系统评价（同质性）
3b 单个病例对照研究
4 病例系列研究（包括低质量队列或病例对照研究）
5 专家意见或评论，基于机制的推论
图1 肝移植术后急性GVHD诊断流程 注：GVHD为移植物抗宿主病
表3 肝移植术后移植物抗宿主病分级
分级 皮肤症状和体征 消化道症状和体征
Ⅰ级 皮疹面积<25%全身体表面积 腹泻500～1 000 ml/d
Ⅱ级 皮疹面积25%～50%全身体表面积 腹泻1 000～1 500 ml/d
Ⅲ级 皮疹面积>50%全身体表面积 腹泻>1 500 ml/d
Ⅳ级 广泛皮疹伴水疱形成 严重腹痛或伴消化道出血
表4 移植物抗宿主病严重程度分型
分型 皮疹 消化道 骨髓抑制
轻型 皮疹<50%全身体表面积 和（或）腹泻<1 500 ml/d -
重型 皮疹>50%全身体表面积伴水疱形成 和（或）腹泻>1 500 ml/d 和（或）明显骨髓抑制
图2 肝移植术后重型移植物抗宿主病治疗流程 注：IVIG为静脉注射免疫球蛋白；GVHD为移植物抗宿主病；HSCT为造血干细胞移植
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