Thải ghép gan cấp điều trị thành công theo phác đồ hỗn hợp giữa thải ghép qua trung gian kháng thế và qua trung gian tế bào T

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Tác giả: Thị Ly Na Bạch, Ánh Dương Đặng, Văn Đô Đỗ, Ngọc Thạch Hoàng, Phạm Anh Hoa Nguyễn, Duy Hiền Phạm, Mạnh Hoàn Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học lâm sàng Bệnh viện Trung ương Huế, 2024

Mô tả vật lý: tr.62-66

Bộ sưu tập: Metadata

ID: 372040

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ABSTRACT CASE REPORT: ACUTE LIVER TRANSPLANT REJECTION SUCCESSFULLY TREATED BY A MIXED OF T - CELL MEDIATED REJECTION AND ANTIBODY - MEDIATED REJECTION Bach Thi Ly Na1, Hoang Ngoc Thach1, Nguyen Pham Anh Hoa1, Dang Anh Duong1, Do Van Do1, Pham Duy Hien1, Vu Manh Hoan1 Acute rejection includes T cell - mediated rejection TCMR and antibody - mediated rejection (AMR). If TCMR is a result of a recipient T - cell mediated immune response targeting the donor allograft resulting in allograft injury of various severity with 20 - 40% after liver transplantation then antibody mediated rejection (AMR) is very rare complication of liver transplantation with a reported frequency of 0,3 - 2%, but can have very serious consequences such as early graft los or cirrhosis. Identifying and treatment AMR remain difficult due to the complexity of immunological and pathology diagnosis, lack of guidelines and long term monitoring. Treatment AMR after liver transplantation is often based on the experience of other centers and the kidney transplant team, including corticoid, plasma exchange, high dose of IVIG , may be combined with rituximab. In this case, we reported a case mixed transplant rejection between TCMR and AMR after liver transplant in a patient with biliary atresia - end stage liver disease with evidence of liver biosy and elevated anti HLA antiobodies (HLA PRA class I and II)U Thải ghép cấp sau ghép gan bao gồm thải ghép cấp qua trung gian tế bào T (TCMR) và thải ghép qua trung gian kháng thể (AMR). Nếu như TCMR là kết quả của phản ứng miễn dịch qua trung gian tế bào T của người nhận tấn công vào mảnh ghép của người hiến, dẫn đến tổn thương mảnh ghép, với tần suất 10 - 40% sau ghép thì AMR là một biến chứng rất hiếm gặp trong ghép gan với tần suất được báo cáo là 0,3 - 2%, nhưng có thể để lại hậu quả rất nghiêm trọng như mất mảnh ghép sớm hay xơ gan [1 - 3]. Xác định và điều trị AMR còn gặp nhiều khó khăn do sự phức tạp trong chẩn đoán miễn dịch và mô bệnh học, thiếu phác đồ điều trị cũng như theo dõi lâu dài. Điều trị tình trạng thái ghép qua trung gian kháng thể sau ghép gan thường dựa trên kinh nghiệm của các trung tâm và trên nhóm ghép thận, bao gồm corticoid, trao đổi huyết tương, IVIG liều cao có thể kết hợp với Rituximab [1, 2]. Trong báo cáo này, chúng tôi báo cáo một ca thải ghép thể hỗn hợp qua trung gian kháng thể và qua trung gian tế bào T trên bệnh nhi teo mật bẩm sinh - bệnh gan giai đoạn cuối sau ghép gan với bằng chứng về sinh thiết gan và sự tăng cao của kháng thể kháng HLA (HLA PRA lớp I và lớp II)

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