Graft vs. host disease after liver transplantation in humans: A report of four cases

Roberts, John P.; Ascher, Nancy L.; Lake, John R.; Capper, J.; Purohit, Sarla; Garovoy, Marvin R.; Lynch, R.E.; Ferrell, Linda D.; Wright, Teresa L.

doi:10.1002/hep.1840140212

Cited by 93 publications

(35 citation statements)

References 13 publications

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“…In 61 cases (60.4%), sepsis was documented as cause of death. The causative organism was reported in 25 cases (41%); invasive aspergillosis was noted in 9 cases 1, 9, 12–17 (36%), disseminated candidiasis in 7 (28%) (3 albicans , 1 kruseii , 1 glabrata and 2 unspecified species) 1, 9, 18, 19 , enterococci in 7 (28%) 1, 20–23 and Enterobacter in 2 (8%) 1, 24 .…”

Section: Resultsmentioning

confidence: 99%

Graft Versus Host Disease After Liver Transplantation in Adults

Murali¹,

Chandra

Stewart

et al. 2016

Transplantation

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Background Graft-versus-host-disease (GVHD) after liver transplantation (LT) is a deadly complication with very limited data on risk factors, diagnosis and management. We report a case series and a comprehensive review of the literature. Methods Data was systematically extracted from reports of GVHD after LT, and from the United Network for Organ Sharing (UNOS) database. Group comparisons were performed. Results 156 adult patients with GVHD after LT have been reported. Median time to GVHD onset was 28 days. Clinical features were skin rash (92%), pancytopenia (78%) and diarrhea (65%). 6-month mortality with GVHD after LT was 73%. Sepsis was the most common cause of death (60%). Enterobacter bacteremia, invasive aspergillosis and disseminated Candida infections were frequently reported. Recipient age over 50-years is a risk factor for GVHD after LT. Hepatocellular carcinoma (HCC) was over-represented, while chronic hepatitis C was under-represented, in reported United States GVHD cases relative to all UNOS database LT cases. Mortality rate with treatment of GVHD after LT was 84% with high-dose steroids alone, 75–100% with regimens using dose increases of calcineurin inhibitors (CNI), and 55% with IL-2 antagonists. Mortality was 25% in small case series using the CD2-blocker alefacept or tumor necrosis factor-α (TNF-α) antagonists. Conclusions Age over 50-years and HCC appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and CNI are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diagnostic algorithm to assist clinicians in managing adults with GVHD after LT.

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Section: Resultsmentioning

confidence: 99%

Graft Versus Host Disease After Liver Transplantation in Adults

Murali¹,

Chandra

Stewart

et al. 2016

Transplantation

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“…6 By contrast, GvHD was not seen among 31 liver transplant patients investigated for diarrhoea at a Scottish transplant centre. 3 Roberts et al 7 reported four cases of colorectal GvHD among a non-selected cohort of 164 liver allograft recipients, but admitted themselves that this was an unexpectedly high incidence. The most common causes of diarrhoea in liver transplant recipients have been recorded in one case series to be (in order of decreasing frequency) Clostridium difficile infection, drugs, cytomegalovirus (CMV) infection, and inflammatory bowel disease; 3 and by others to be CMV and C. difficile infection and mycophenolate mofetil (MMF) toxicity, followed by other drugs and then inflammatory bowel disease.…”

Section: Spectrum Of Diseasesmentioning

confidence: 99%

Gastrointestinal pathology in transplant patients

Wong

2014

Histopathology

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The assessment of gastrointestinal (GI) specimens from transplant patients is complicated by the wide range of potentially rare pathologies that may be found in this clinical setting. Acute GI graft-versus-host disease (GvHD) is characterized by epithelial cell apoptosis, although there is increasing recognition that acute and/or chronic inflammation may also be present. By contrast, thus far there are no histological features known to be specific to chronic GI GvHD. Mycophenolate mofetil colitis may mimic both GvHD and inflammatory bowel disease, whereas both cytomegalovirus (CMV) and adenovirus infections can cause gland apoptosis. Post-transplant lymphoproliferative disorder should be considered if a Crohn's-like histological picture is seen, and granulomas in biopsies from umbilical cord blood recipients should raise a suspicion of cord colitis syndrome. Finally, the GI tract may be involved directly or indirectly by the disease that originally required haematopoietic stem cell or liver transplantation.

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“…With human liver transplantation, preoccupation with rejection obscured the fact until recently that the GVH reaction, which is an incipient process and a requisite for sustained engraftment in every case, can evolve to serious or fatal syndromes (124)(125)(126)(127)(128)(129)(130) in the early postoperative period. Clinically significant GVHD is observed in our liver program in approximately 5% of cases, manifesting as dermatitis.…”

Section: Failure Of Mixed Chimerismmentioning

confidence: 99%