Graft-versus-host disease of the central nervous system after liver transplantation: A rare complication

Pahari, Hirak; Nagai, Shunji; Skorupski, Sharon; Salgia, Reena

doi:10.1111/ajt.14981

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…The median follow-up period after LT was 84 days (IQR, 45–180), 2 , 4 , 11 – 13 , 15 – 19 , 21 , 22 , 24 , 26 – 31 , 33 , 35 , 37 – 39 , 43 , 44 , 46 – 61 , 64 , 66 – 72 , 74 , 75 , 77 – 80 , 82 , 83 , 85 , 86 , 88 – 97 , 99 – 108 , 111 – 120 , 122 , 124 – 129 whereas the median follow-up period following GvHD onset was 32 days (IQR, 19–67). 11 – 13 , 15 , 17 – 19 , 22 – 24 , 26 – 31 , 33 , 36 – 39 , 42 , 44 , 46 – 49 , 51 , 53 – 58 , 60 , 61 , 64 , 66 , 67 , 69 – 72 , 74 , 75 , 77 – 83 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Few data refer to the therapeutic regime of GvHD following SOT in the current literature. Furthermore, the majority of cases have been published as case reports; 2 – 4 , 16 – 18 , 22 , 25 , 28 , 30 , 31 , 34 – 38 , 42 – 46 , 48 – 54 , 56 , 58 , 60 , 61 , 65 , 67 , 69 – 77 , 80 – 90 , 92 , 95 – 103 , 105 – 109 , 111 – 120 , 122 – 128 , 130 , 132 – 134 , 138 – 141 thus, obtaining an overview of this sophisticated topic is aggravated. Treatment options for SOT-GvHD are also controversial as there is limited evidence given the scarcity and unaltered high mortality of cases, foreclosing a conclusive evidence-based therapy recommendation.…”

Section: Discussionmentioning

confidence: 99%

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Graft-versus-host disease following liver transplantation: A systematic review of literature

Kneifel,

Vogel,

Bormann

et al. 2023

Hepatology Communications

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Background: Graft-versus-host disease following liver transplantation is a serious and usually fatal complication. Data identifying the risk factors and specifying the diagnosis and treatment options of the disease are scarce and contentious. Moreover, recommendations for therapeutic approaches are similarly sparse. Methods: A systematic review of the literature from 1988 to 2020 on graft-versus-host disease following liver transplantation was performed using the PubMed and MEDLINE databases. Medical subject headings, such as graft-versus-host disease and GvHD were used in combination with solid organ transplant, transplantation, or liver transplant. Following duplicate removal, 9298 articles were screened for suitability. A total of 238 full-text articles were analyzed for eligibility, resulting in 130 eligible articles for meta-analysis. Two hundred twenty-five patients developing graft-versus-host disease following liver transplantation reported herein were mainly published in case reports and case series. Results: Graft-versus-host disease occurred with an incidence of 1.2%. 85% developed following deceased donor liver transplant and 15% following living-related donor liver transplantation. The median follow-up period following liver transplantation was 84 days (interquartile range, 45–180). The median time from liver transplantation to graft-versus-host disease onset was 30 days (interquartile range, 21–42). The main clinical features included skin rash (59%), fever (43%), diarrhea (36%), and pancytopenia (30%). The overall mortality rate was 71%. Neither univariate (HR = 0.999; 95% CI, 0.493–2.023; p = 1.0) nor multivariate Cox regression analysis revealed a significant correlation between adaptation of immunosuppression and survival probability (HR = 1.475; 95% CI, 0.659–3.303; p = 0.3). Conclusions: This systematic review suggests that an increase in immunosuppressive regimen does not yield any survival benefit in patients suffering from graft-versus-host disease following liver transplantation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Graft-versus-host disease following liver transplantation: A systematic review of literature

Kneifel,

Vogel,

Bormann

et al. 2023

Hepatology Communications

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“…In particular, organs such as kidney, CNS, and lungs may be involved in patients experiencing aGVHD after allogeneic hematopoietic stem cell transplantation. Pahari et al [ 18 ] reported the first case of CNS-GVHD following LT. Subsequently, seizures and altered mental status were recorded, and the patient died of sepsis and multiorgan failure.…”

Section: Discussionmentioning

confidence: 99%

“…, donor lymphocyte chimerism in recipient tissues (peripheral blood, skin, GI tract, bone marrow, or buccal mucosa), especially with a high proportion of CD8+ T cells, persists 3-4 wk after LT and thus is associated with the eventual development of GVHD. Recently, chimerism analysis assessed the donor DNA using fluorescent in situ hybridization and the short tandem repeat (STR) loci to quantitate the donor’s contribution to any of the nucleated cell populations in the skin, peripheral blood, GI mucosa, and/or bone marrow, and cerebrospinal fluid[ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases

Tian¹,

Lyu²,

Wang³

et al. 2021

WJCC

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BACKGROUND Graft-versus-host disease (GVHD) following liver transplantation (LT) is an unpredictable complication with poor outcome. However, consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking. The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD (aGVHD) following LT and reviewed the pertinent literature. CASE SUMMARY Between January 1 st , 2000 and December 31 st , 2020, a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University. Six recipients developed aGVHD with clinical symptoms of fever, rash, diarrhea, and pancytopenia. The incidence of aGVHD was 0.57%. The median time from LT to the clinical presentation of aGVHD was 22.17 d. The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d. All six cases underwent treatment of immunosuppressant adjustment, corticosteroids, human normal immunoglobulin, and antithymocyte globulin/IL-2 antagonists. Despite intensive treatment strategies, 4 patients were deceased due to sepsis, multiple organ failure, and cerebral hemorrhage. The remaining two cases were discharged as treatment successfully. However, one died because of tuberculosis infection on the 6th month of follow-up, the other one was alive healthy during 30 mo of follow-up. CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom, histopathological features, and the donor T-lymphocyte chimerism. Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD. Moreover, gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.

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“…Clinical manifestations include encephalopathy, seizures, and focal neurologic deficits such as hemiparesis. [62][63][64][65][66]…”

Section: Cns Graft Versus Host Diseasementioning

confidence: 99%

Approach to Neurologic Complications in the Immunocompromised Patient

Vishnevetsky

Anand

2021

Semin Neurol

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Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.

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Graft-versus-host disease of the central nervous system after liver transplantation: A rare complication

Cited by 6 publications

References 17 publications

Graft-versus-host disease following liver transplantation: A systematic review of literature

Graft-versus-host disease following liver transplantation: A systematic review of literature

Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases

Approach to Neurologic Complications in the Immunocompromised Patient

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