Forma aguda da doença enxerto contra o hospedeiro após transplante de fígado. Existe opção terapêutica para as formas refratárias ao tratamento com esteróides?

  • Eleazar Chaib Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
  • Brian Guilherme Monteiro Marta Coimbra Universidade de São Paulo, Faculdade de Medicina
  • Felipe Duarte Silva Universidade de São Paulo, Faculdade de Medicina
  • Alexandre Fligelman Kanas Universidade de São Paulo, Faculdade de Medicina
  • Eduardo Ryoiti Tatebe Universidade de São Paulo, Faculdade de Medicina
  • Myris Satiko Shinzato Universidade de São Paulo, Faculdade de Medicina
  • Flavio Henrique Ferreira Galvão Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
  • Luiz Augusto Carneiro D’Albuquerque Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
Palavras-chave: Liver transplantation, Graft vs host disease/etiology, Grafts vs host disease/therapy, Pathogenesis/treatment, Steroids/therapeutic use.

Resumo

Background: Acute graft-versus-host disease (GVHD) usually occurs by 8 weeks after liver transplantation (LT) usually is an uncommon complication but has both high mortality and major diagnostic challenge in addition most of them are associated with resistance to steroid therapy. Objective: Discuss the pathogenesis, treatment and long-term results of Acute Graft versus Host Diseaseafter Liver Transplantation. Methods: A PubMed search was performed to identify all reported cases of GVHD following LT. The medical subject heading GVHD disease was used in combination with LT, including adults (19 + years) and children. The bibliographiesof the articles found though PubMed were then searched for further reports of GVHD. Results: We reviewed 102 cases of acute GVHD, 96 (94.1%) adults and 6 (5.8%) children. After treatment24 (25%) adults and 3 (50%) children were alive only. As far as the treatment of GVHD is concern the therapy used in adults and in children patients was respectively : anti-thymocyte globulin + prednisolone – 19 (19.5%); interleukin-2 receptor blocker – 17 (17.5%); OKT3 – 12 (12.3%); cyclosporine – 9 (9,2% ); others – 39 (40.2%) and in children anti-thymocyte globulin – 1 (20%); anti-thymocyte globulin + prednisolone – 1 (20%); prednisolone – 1 (20%); anti-thymocyte globulin + prednisolone + interleukin-2 receptor blocker-1 (20%); not mentioned – 1.There was no standard treatment of acute GVHD for both children and adults. Conclusion: Although acute GVHD following LT is rare complication and mortalityis still very high, there is no consensus for the treatment of steroid-refractory forms. Further researches are needed to provide new approach for treating effectively such condition.

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Biografia do Autor

Eleazar Chaib, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
Associate Professor of Surgery, Director Experimental Research Laboratory- LIM 37, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Brian Guilherme Monteiro Marta Coimbra, Universidade de São Paulo, Faculdade de Medicina
Medical Student, University of São Paulo School of Medicine, São Paulo, Brazil.
Felipe Duarte Silva, Universidade de São Paulo, Faculdade de Medicina
Medical Student, University of São Paulo School of Medicine, São Paulo, Brazil.
Alexandre Fligelman Kanas, Universidade de São Paulo, Faculdade de Medicina
Medical Student, University of São Paulo School of Medicine, São Paulo, Brazil.
Eduardo Ryoiti Tatebe, Universidade de São Paulo, Faculdade de Medicina
Medical Student, University of São Paulo School of Medicine, São Paulo, Brazil.
Myris Satiko Shinzato, Universidade de São Paulo, Faculdade de Medicina
Medical Student, University of São Paulo School of Medicine, São Paulo, Brazil.
Flavio Henrique Ferreira Galvão, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
Assistant Professor of Surgery. LIM 37, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Luiz Augusto Carneiro D’Albuquerque, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
Professor of Transplantation Surgery, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Publicado
2012-06-18
Como Citar
Chaib, E., Coimbra, B. G., Silva, F., Kanas, A., Tatebe, E., Shinzato, M., Galvão, F. H., & D’Albuquerque, L. A. (2012). Forma aguda da doença enxerto contra o hospedeiro após transplante de fígado. Existe opção terapêutica para as formas refratárias ao tratamento com esteróides?. Revista De Medicina, 91(2), 110-116. https://doi.org/10.11606/issn.1679-9836.v91i2p110-116
Seção
Artigos