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

doi:10.3877/cma.j.issn.2095-3232.2024992

Abstract

Abstract:

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 may involve 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

of Organ Transplant of China Medical Association Branch, of Organ Transplant Physicians of Chinese Medical Doctor Association Branch. 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), 2025, 14(01): 1-12.

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References 116

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项目	等级分数（分）
项目	2	1	0	-1	-2
干预措施的	明显利	可能利	利弊相当	可能弊	明显弊
利弊权衡	大于弊	大于弊	或不确定	大于利	大于利
推荐强度	强推荐	弱推荐	无明确	弱不推荐	强不推荐

项目	等级分数（分）
项目	2	1	0	-1	-2
干预措施的	明显利	可能利	利弊相当	可能弊	明显弊
利弊权衡	大于弊	大于弊	或不确定	大于利	大于利
推荐强度	强推荐	弱推荐	无明确	弱不推荐	强不推荐

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

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

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

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