Infectious complications in acute graft‐versus‐host disease after liver transplantation

Abstract

Graft-versus-hostdisease (GVHD) following liver transplantation (LT) is rare but can lead tosignificant mortality. The leading cause of death following GVHD diagnosis isinfectious complications. However, there is a lack of clear descriptions concerning infection and antimicrobial management patterns. Our study aims toprovide the focused details of all infectious complications of acute GVHDfollowing LT.We retrospectively reviewed all adult LT recipients with acute GVHD at Mayo Clinic's Transplant Centers from January 1, 2010, to December 31, 2021. Detailed characteristics of infection in each case were described. Among 4,585 LTs performed during this period, 12 (0.3%) patients developed acuteGVHD. The median time from transplantation to GVHD diagnosis was 49.0 days [IQR 31.5-99.0]. Ten (83.3%) patients developed severe infections leading tomortality. The most common cause of infection was nosocomial bacteremia fromenteric bacteria such as vancomycin-resistant enterococci and gram-negative bacilli. Other infections included breakthrough invasive fungal infections,cytomegalovirus (CMV) reactivation, and Clostridioides difficile colitis. Antimicrobial prophylaxis strategies in most cases were based on the degree of neutropenia-these include levofloxacin for bacterial prophylaxis, nebulized pentamidine for Pneumocystis jiroveci pneumonia prophylaxis, posaconazole for invasive fungal prophylaxis, and valganciclovir based on CMVstatus. All GVHD patients with severe infections succumbed to thesecomplications. Ourstudy reiterates that despite prophylaxis, infectious complications in GVHDfollowing LT are common and lead to exceptionally high mortality. Individualizedantimicrobial treatment, prophylaxis and monitoring strategies remain a criticalcomponent of GVHD management. Further study to optimize these practices isrequired.

Development of graft-versus-host disease in a liver recipient. Clinical observations and literature review

“…К основным причинам смерти этих пациентов относят инфекционные осложнения, которые на фоне глубокой нейтропении приобретают септическое течение. Так, у 10 (83,3%) из 12 реципиентов печени с острой РТПХ, наблюдавшихся в Клинике Мейо (Рочестер, США), развились тяжелые инфекции, приведшие к летальному исходу [6]. Наиболее часто выявлялась нозокомиальная бактериемия, вызванная кишечными бактериями, такими как устойчивые к ванкомицину энтерококки и грамотри-цательные палочки.…”

“…Исследователи из той же клиники недавно сообщили о 0,3% частоте развития РТПХ (12 случаев) при анализе всех ТП, выполненных с 1 января 2010 г. по 31 декабря 2021 г. (4585 операций) [6]. При анализе базы данных OPTN, включавшей 77,416 взрослых пациентов, перенесших ТП в период с 2003-го по 2018 год, был выявлен 121 (0,2%) случай фатальной РТПХ после ТП [7].…”

Acute Graft-Versus-Host Disease: A Comprehensive Review of Management and Recent Advances

“…Acute GVHD can target diverse organs, including the lungs, kidneys, thymus, lymph nodes, bone marrow, and the central nervous system. These atypical manifestations may be subtle and challenging to differentiate from other post-transplant complications [Chesdachai, 2022]. Acute GVHD is systematically graded based on the extent of organ involvement and severity.…”