Early Outcomes of Ruxolitinib in the Treatment of Steroid Refractory Graft-versus-host Disease on Liver Transplant Recipients

JAK Inhibitors in Solid Organ Transplantation

“…Finally, despite some encouraging results, there is not sufficient evidence for the efficacy of JAK inhibitors in managing acute GvHD after solid organ transplantation. In fact, the low number of case reports, the critical situation of steroid‐refractory patients, the overlap between symptoms of GvHD and adverse effects of JAK inhibitors, and the old age of most cases render our present knowledge inconclusive 69–71,73 …”

“…In fact, the low number of case reports, the critical situation of steroid-refractory patients, the overlap between symptoms of GvHD and adverse effects of JAK inhibitors, and the old age of most cases render our present knowledge inconclusive. [69][70][71]73 Taken together, the number of in vitro, in vivo, animal, and clinical studies about the efficacy and safety of JAK inhibitors in the regulation of alloimmune responses and improving allograft survival is far fewer than is required to propose these drugs as regular immunosuppressants in solid organ transplantation. Nonetheless, they might be considered as a secondline therapy for the management of high-risk recipients and refractory cases.…”

“…The latter case, transplanted for nonalcoholic steatohepatitis, was successfully treated with ruxolitinib and his GvHD symptoms subsided. This patient also developed various infections and cytopenia, which resolved after stopping ruxolitinib 71 . The next case was a 62‐year‐old man transplanted for alpha‐1 antitrypsin deficiency cirrhosis, who, despite an initial improvement of skin lesions with ruxolitinib, developed pancytopenia, renal failure, and severe bacteremia, and expired as a result of septic shock 72 …”

“…This patient also developed various infections and cytopenia, which resolved after stopping ruxolitinib. 71 The next case was a 62-year-old man transplanted for alpha-1 antitrypsin deficiency cirrhosis, who, despite an initial improvement of skin lesions with ruxolitinib, developed pancytopenia, renal failure, and severe bacteremia, and expired as a result of septic shock. 72 Then, 2 more cases with post-liver transplant GvHD were reported.…”