"27" . "Ost\u0159\u00ED\u017Eek, Tom\u00E1\u0161" . . . "Graft-versus-host disease as an ununsual comlication following liver transplant"@en . . "RIV/00209775:_____/12:#0000238" . "417 orthotopic transplants were carried out at the Brno transplant centre between 2 February 1983 and 1 December 2011. Graft-versus-host disease (GVHD) was diagnosed in a single case (0.24%). The authors describe the case of a 59 year-old-woman who underwent liver transplant due to secondary biliary cirrhosis following iatrogenic damage of the ductus choledochus during cholecystectomy. Following the liver transplant, the patient developed skin exanthem accompanied by diarrhoea, followed by leukopenia and septic shock development. The GVHD diagnosis was tested by skin biopsy and supported by determing the presence of the proportion of donor cells in the recipient\u00B4s peripheral blood (chimerism). The treatment involved applying high doses of glucocorticoids, maintaining the lowest possible effective levels of tacrolimus, administering immunoglobulins, anti-CD25 mAbs, and symptomatic therapy (factor stimulating granulocytes, antibiotics and antivirotics). Despite the very complicated course, the patient improved both subjectively and objectively and the GVHD symptoms gradually subsided. However, the condition was accompanied by a distinctive leukopenia with sepsis developed. The above-mentioned therapy resulted in a gradual improvement of both the clinical condition and the laboratory results as well as in the discharge after 77 days from the transplant. However, after another 10 days skin symptoms reoccurred, which subsided again after increasing glucocorticoids and reducing the dose of calcineurin inhibitors. This condition was accompanied by neither leukopenia nor sepsis. The patient had recovered again by the 252nd day after the transplant with heart failure involving bioptically proven viral myocarditis. The patients is now 10 months after the liver transplant without any GVHD clinical symptoms and with good functioning of the liver graft."@en . . "CZ - \u010Cesk\u00E1 republika" . "V" . "V transplanta\u010Dn\u00EDm centru v Brn\u011B bylo provedeno 417 ortotopick\u00FDch transplantac\u00ED jater v obdob\u00ED od 2.2.1983 do 1.12.2011. Graft vs host disease (GVHD) byla diagnostkov\u00E1na pouze v jednom p\u0159\u00EDpad\u011B (0,24%). Auto\u0159i popisuj\u00ED p\u0159\u00EDpad 59let\u00E9 \u017Eeny, u kter\u00E9 byla transplantace jater provedena pro sekund\u00E1rn\u00ED bili\u00E1rn\u00ED cirh\u00F3zu po iatrogenn\u00EDm po\u0161kozen\u00ED ductus choledochus p\u0159i cholecystectomii. U pacientky se po transplantaci jater rozvinul ko\u017En\u00ED exant\u00E9m prov\u00E1zen\u00FD pr\u016Fjmy s n \u00E1slednou leukopeni\u00ED a rozvojem septick\u00E9ho \u0161oku. Diagn\u00F3za GVHD byla ov\u011B\u0159ena ko\u017En\u00ED biopsi\u00ED a podpo\u0159ena stanoven\u00EDm p\u0159\u00EDtomnosti pod\u00EDlu d\u00E1rcovsk\u00FDch bun\u011Bk v perifern\u00ED krvi p\u0159\u00EDjemce (chimerizmus). V l\u00E9\u010Db\u011B byly pou\u017Eityvysok\u00E9 d\u00E1vky glukokortikoid\u016F, udr\u017Eov\u00E1n\u00ED co nejni\u017E\u0161\u00EDch \u00FA\u010Dinn\u00FDch hladin tacrolimu, pod\u00E1n\u00ED imunoglobulin\u016F, anti-CD25 mAbs, symptomatick\u00E1 terapie (faktor stimuluj\u00EDc\u00ED granulocyty, antibiotika, antivirotika). I p\u0159es velmi komplikovan\u00FD pr\u016Fb\u011Bh se pacientka subjektivn\u011B i objektivn\u011B zlep\u0161ila a p\u0159\u00EDznaky GVHD postupn\u011B odezn\u011Bly. Stav byl v\u0161ak prov\u00E1zen v\u00FDraznou leukopeni\u00ED s rozvojem septick\u00E9ho stavu. V\u00FD\u0161e uveden\u00E1 terapie vedla k postupn\u00E9 \u00FAprav\u011B jak klinick\u00E9ho stavu, tak laboratorn\u00EDch v\u00FDsledk\u016F a mo\u017Enosti propu\u0161t\u011Bn\u00ED po 77 dnech od transplantace. Po n\u00E1sleduj\u00EDch 10 dnech v\u0161ak doch\u00E1z\u00ED k nlv\u00E9mu v\u00FDskytu ko\u017En\u00EDch projev\u016F, kter\u00E9 po nav\u00FD\u0161en\u00ED glukokortikoid\u016F a redukci d\u00E1vky blok\u00E1tor\u016F kalcineurinu op\u011Bt ustoupily. Tento stav ji\u017E nebyl prov\u00E1zem leukopeni\u00ED ani septick\u00FDm stavem. Nemocn\u00E1 byla op\u011Btovn\u011B hospitalizov\u00E1na 252. den po transplantaci s rozvojem srde\u010Dn\u00EDho selh\u00E1n\u00ED s biopticky prok\u00E1zanou virovou myokarditidou. Pacientka je nyn\u00ED 10 m\u011Bs\u00EDc\u016F po transplantaci jater bez klinick\u00FDch zn\u00E1mek GVHD s dobrou funkc\u00ED jatern\u00EDho \u0161t\u011Bpu."@cs . . "\u017Dampachov\u00E1, V." . . . . . "Graft versus host disease jako neobvykl\u00E1 komplikace po transplantaci jater" . . "66" . . "V transplanta\u010Dn\u00EDm centru v Brn\u011B bylo provedeno 417 ortotopick\u00FDch transplantac\u00ED jater v obdob\u00ED od 2.2.1983 do 1.12.2011. Graft vs host disease (GVHD) byla diagnostkov\u00E1na pouze v jednom p\u0159\u00EDpad\u011B (0,24%). Auto\u0159i popisuj\u00ED p\u0159\u00EDpad 59let\u00E9 \u017Eeny, u kter\u00E9 byla transplantace jater provedena pro sekund\u00E1rn\u00ED bili\u00E1rn\u00ED cirh\u00F3zu po iatrogenn\u00EDm po\u0161kozen\u00ED ductus choledochus p\u0159i cholecystectomii. U pacientky se po transplantaci jater rozvinul ko\u017En\u00ED exant\u00E9m prov\u00E1zen\u00FD pr\u016Fjmy s n \u00E1slednou leukopeni\u00ED a rozvojem septick\u00E9ho \u0161oku. Diagn\u00F3za GVHD byla ov\u011B\u0159ena ko\u017En\u00ED biopsi\u00ED a podpo\u0159ena stanoven\u00EDm p\u0159\u00EDtomnosti pod\u00EDlu d\u00E1rcovsk\u00FDch bun\u011Bk v perifern\u00ED krvi p\u0159\u00EDjemce (chimerizmus). V l\u00E9\u010Db\u011B byly pou\u017Eityvysok\u00E9 d\u00E1vky glukokortikoid\u016F, udr\u017Eov\u00E1n\u00ED co nejni\u017E\u0161\u00EDch \u00FA\u010Dinn\u00FDch hladin tacrolimu, pod\u00E1n\u00ED imunoglobulin\u016F, anti-CD25 mAbs, symptomatick\u00E1 terapie (faktor stimuluj\u00EDc\u00ED granulocyty, antibiotika, antivirotika). I p\u0159es velmi komplikovan\u00FD pr\u016Fb\u011Bh se pacientka subjektivn\u011B i objektivn\u011B zlep\u0161ila a p\u0159\u00EDznaky GVHD postupn\u011B odezn\u011Bly. Stav byl v\u0161ak prov\u00E1zen v\u00FDraznou leukopeni\u00ED s rozvojem septick\u00E9ho stavu. V\u00FD\u0161e uveden\u00E1 terapie vedla k postupn\u00E9 \u00FAprav\u011B jak klinick\u00E9ho stavu, tak laboratorn\u00EDch v\u00FDsledk\u016F a mo\u017Enosti propu\u0161t\u011Bn\u00ED po 77 dnech od transplantace. Po n\u00E1sleduj\u00EDch 10 dnech v\u0161ak doch\u00E1z\u00ED k nlv\u00E9mu v\u00FDskytu ko\u017En\u00EDch projev\u016F, kter\u00E9 po nav\u00FD\u0161en\u00ED glukokortikoid\u016F a redukci d\u00E1vky blok\u00E1tor\u016F kalcineurinu op\u011Bt ustoupily. Tento stav ji\u017E nebyl prov\u00E1zem leukopeni\u00ED ani septick\u00FDm stavem. Nemocn\u00E1 byla op\u011Btovn\u011B hospitalizov\u00E1na 252. den po transplantaci s rozvojem srde\u010Dn\u00EDho selh\u00E1n\u00ED s biopticky prok\u00E1zanou virovou myokarditidou. Pacientka je nyn\u00ED 10 m\u011Bs\u00EDc\u016F po transplantaci jater bez klinick\u00FDch zn\u00E1mek GVHD s dobrou funkc\u00ED jatern\u00EDho \u0161t\u011Bpu." . . "\u0160t\u011Bp\u00E1nkov\u00E1, So\u0148a" . . "Gastroentologie a hepatologie" . . "Graft versus host disease jako neobvykl\u00E1 komplikace po transplantaci jater"@cs . "Kuman, Milan" . . "Husov\u00E1, Libu\u0161e" . "Jedli\u010Dkov\u00E1, H." . "7"^^ . . . "Graft versus host disease jako neobvykl\u00E1 komplikace po transplantaci jater"@cs . . "Graft versus host disease jako neobvykl\u00E1 komplikace po transplantaci jater" . "N\u011Bmec, Petr" . "Graft-versus-host disease as an ununsual comlication following liver transplant"@en . "6"^^ . "[9363CBB54D56]" . "8"^^ . . "Mejzl\u00EDk, Vladim\u00EDr" . "1804-7874" . "RIV/00209775:_____/12:#0000238!RIV13-MZ0-00209775" . "138368" . "http://csgh.info" . . "exanthema; graft-versus-host disease; liver transplant"@en .