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【medical-news】澳大利亚一女孩肝移植手术后血型
Thu Jan 24, 12:56 PM ET
SYDNEY (AFP) -An Australian girl spontaneously changed blood groups and adopted her donor's immune system after a liver transplant, in what doctors treating her said Thursday was the first known case of its type.
Demi-Lee Brennan was aged nine and seriously ill with liver failure when she received the transplant, doctors at a top Sydney children's hospital told AFP.
Nine months later they discovered she had changed blood types and that her immune system had switched over to that of the donor after stem cells from the new liver migrated to her bone marrow.
She is now a healthy 15-year-old, Michael Stormon, a hepatologist treating her, told AFP. He said he had given several presentations on the case around the world and had heard of none like it.
"It is extremely unusual -- in fact we don't know of any other instance in which this happened," Stormon told AFP from the Children's Hospital at Westmead.
"In effect she had had a bone marrow transplant. The majority of her immune system had also switched over to that of the donor."
An article on the case was published in Thursday's edition of the leading US medical journal The New England Journal of Medicine.
Brennan's mother Kerrie Mills described the recovery as "miraculous" while the patient herself told a news conference that doctors had given her life back to her.
"I just can't thank them enough. It's like my second chance at life," Brennan said.
Doctors who treated Brennan are interested to know if the case could have other applications in transplant surgery, where rejection of donor organs by the recipient's immune system is a major hurdle.
Stormon said it appeared that Brennan may have been fortunate because a "sequence of serendipitous events", including a post-transplantation infection, may have given the stem cells from her donor's liver the chance to proliferate in the bone marrow, where blood cells develop.
The task now was to establish whether the same sort of outcome could be replicated in other transplant patients, he said.
"The challenge for us now is to try and figure out how this occurred," Stormon said.
One possibility is that the series of events she experienced all weakened her immune system enough for the stem cells to migrate to the bone marrow and proliferate, Stormon said.
These factors include the particular type of liver failure she had, a post-operation infection with the virus cytomegalovirus, and immunosuppressive drugs.
"To try to replicate that is easier said than done," Stormon said, but added the case could still potentially be of crucial importance.
"The holy grail of transplant medicine is immuno-tolerance. She exemplifies that this can occur."
http://news.yahoo.com/s/afp/20080124/hl_afp/australiahealthchildrentransplant;_ylt=AtowE9QNGFWlbp_qO_9G7K7VJRIF 本人认领此文编译，若48小时未上传，请其他战友自由认领。 来自新浪的报道:
http://www.sina.com.cn 2008年01月25日18:07 新华网
http://news.sina.com.cn/h/2008-01-25/180714828978.shtml
澳大利亚肝移植女孩术后改变血型 尚属世界首例 这是很重要的发现, 给科学家们许多启示.
供体干细胞是否或如何改变受体的血型和免疫系统, 大有文章可做.
需要关注跟踪这方面的进展. 或许新的竞赛已经开始 Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant
SUMMARY
Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The tolerance was preceded by a period of severe hemolysis, reflecting partial chimerism that was refractory to standard therapies. The hemolysis resolved after the gradual withdrawal of all immunosuppressive therapy.
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Case Report
Acute fulminant hepatitis after a nonspecific viral illness developed in a previously well 9-year-old girl. Her blood group was O, RhD-negative. She was referred to our institution, and at the time of admission she had markedly elevated aminotransferase levels and evidence of marked synthetic dysfunction (Table 1). Extensive testing ruled out known viral, metabolic, drug-related, and autoimmune causes, and a diagnosis of "non–A-to-G viral hepatitis" was made. A liver biopsy was not performed because of severe underlying coagulopathy.
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作者:admin@医学,生命科学 2011-03-28 17:14
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