儿童肝移植术后罕见药物性肝损害1例报道并文献复习

目的探讨儿童肝移植术后药物性肝损害的诊疗经验。方法回顾性分析1例小儿肝移植术后药物性肝损害病例的临床资料并进行文献复习。结果患儿于肝移植术后1年4月余出现肝功能异常,其中血碱性磷酸酶(alkalinephos phatase,ALP)水平明显升高,经除外急性排斥反应、维生素D缺乏性佝偻病、胆汁淤积性疾病、病毒感染、骨代谢异常、甲状旁腺功能亢进症及血液系统疾患等原因后,考虑为他克莫司(FK506)不良反应所致肝损害,停用FK506,改为麦考酚吗乙酯(MMF)+环孢素(CsA)抗排斥治疗后,患儿肝功能逐渐好转。结论儿童患者的生理及药物代谢具有特殊性,小儿肝移植术后FK506所致药物性肝损害较为罕见,临床上应予以重视。

Rare drug-induced liver damage after pediatric liver transplantation: a case report and literature review

Objective To investigate the experience of diagnosis and treatment of drug-induced liver damage after pediatric liver transplantation. Methods Clinical data of one case of drug-induced liver damage after pediatric liver transplantation were retrospectively analyzed and related literature was reviewed. Results The pediatric patient developed abnormal liver function at 16 months after liver transplantation, with significantly increased level of alkaline phosphatase(ALP). After rulling out the causes such as acute rejection, rickets of vitamin D deficiency, cholestatic disease, virus infections, abnormal bone metabolism, hyperparathyroidism, hematological disorder and so on, adverse reaction of tacrolimus(FK506)was considered as the cause of liver damage. After changing the immunosuppressant from FK506 to mycophenolate mofetil(MMF) combined with ciclosporin(CsA)for anti-rejection treatment, her liver function gradually improved. Conclusions There is particularity in physiology and drug metabolism in pediatric patients. Drug-induced liver damage by FK506 is rare in pediatric liver transplantation. More clinical attention should be paid to this condition.