Successful Outcome of Acute Graft-Versus-Host Disease in a Liver Allograft Recipient by Withdrawal of Immunosuppression

Abstract

Withdrawal of immunosuppressive therapy is a promising approach in the treatment of acute GVHD to allow the patient's immune system to reconstitute itself, reject offending lymphocytes, and avoid lethal septic complications.

Treatment of Graft-Versus-Host Disease After Liver Transplantation with Basiliximab Followed by Bowel Resection

“…The favorable outcome in these two cases may be because treatment with Basiliximab was commenced before pancytopenia was evident. This does not necessarily mean that there was no occult bone-marrow involvement, which has been described previously (19,20,22,23).…”

Graft versus Host Disease after Orthotopic Liver Transplantation Documented by Analysis of Short Tandem Repeat Polymorphisms

“…Our patient received an organ from a cadaveric liver donor with a one-way HLA match in the graft rejection direction and two mismatches at the HLA-B and Cw loci in the GVHD direction. The risk of GVHD in patients receiving a graft with only 0–1 antigen mismatches at HLA-A and HLA-B and sharing at least one HLA-DR antigen is 22%, which is considerably higher than the 1% risk for GVHD if 3–4 antigen mismatches are present at these loci [4, 9]. In addition, the one-way HLA match in the graft rejection direction probably puts the patient at an even higher risk of GVHD.…”

“…Our treatment efforts were high-dose corticosteroids in the beginning after diagnosis; later on, as no therapeutic response was seen, immunosuppressive therapy was reduced and corticosteroids were withdrawn [4,5,6]. However, it can only be speculated whether a complete secession of immunosuppressive treatment, which was not done in our case, would have been able to mount a sufficiently strong immune response towards minor histocompatibility antigens of the donor lymphocytes to eliminate them successfully.…”

“…We used high-dose corticosteroids in the beginning after the diagnosis of GVHD; later on, as no therapeutic response was seen, immunosuppressive therapy was reduced and corticosteroids were withdrawn [4,5,6]. Thrombocytopenia had to be corrected frequently with thrombocyte concentrates and neutropenia responded in the beginning favorably to the administration of colony-stimulating factor G-CSF (filgrastim) with an increase in neutrophil counts as seen by others.…”

Graft-versus-host disease following living donor liver transplantation: high risk when the donor is HLA‐homozygous

“…In full allogeneic combinations, immunosuppressive therapy may be reduced or even withdrawn, to allow the patient's own immune system to eliminate donor cells [11]. This therapeutic option is impossible in the HLA-homozygous donor in a haploidentical recipient combination, since the recipient immune system is unable to eliminate the donor immune cells in this special case.…”