Novel Application of Extracorporeal Photopheresis as Treatment of Graft-versus-Host Disease Following Liver Transplantation

Abstract

A 48-year-old man with hepatitis C virus (HCV) cirrhosis complicated by hepatocellular carcinoma underwent liver transplantation. His course was complicated by fever, diarrhea, abdominal pain, and pancytopenia. He developed a diffuse erythematous rash, which progressed to erythroderma. Biopsies of the colon and skin were consistent with acute graft-versus-host disease. Donor-derived lymphocytes were present in the peripheral blood. The patient was treated with corticosteroids and cyclosporine; however, he had minimal response to intensive immunosuppressive therapy. Extracorporeal photopheresis was initiated as a salvage therapy. He had a dramatic response, and his rash, diarrhea, and pancytopenia resolved. He is maintained on minimal immunosuppression 24 months later.

Extracorporeal photopheresis: A case of graft‐versus‐host‐disease and hemophagocytic lymphohistiocytosis following liver transplantation

“…GVHD was unresponsive to steroids, multiple immunosuppressive agents, biologics, in addition to ECP. In adults, ECP use has been reported in GVHD with good outcomes following multivisceral organ transplantation, 13 liver transplantation, 14 and simultaneous pancreas‐kidney transplantation 15 . Houston et al reported the use of ECP in a 28‐year‐old man on Days 62 and 67 post multivisceral organ transplantation with reduction in chimerism over 9 days; however, the patient died of sepsis on Day 73 16 .…”