Successful treatment of Graft-vs-Host disease after a second liver transplant

Aziz, H; Trigo, Pedro; Lendoire, Javier; Bianco, Giuseppe; Saul, J. P.; Braslavsky, G; Kien, María Cristina; Zylberman, Marcelo; Imventarza, G. Cueto O.

doi:10.1016/s0041-1345(98)00857-4

Cited by 17 publications

(9 citation statements)

References 8 publications

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“…In that study, 2 patients suspected of having acute GVHD after OLT had higher levels than this (84% and 10%, respectively, of donor lymphocytes) 52. Cases have been reported in which documentation of chimerism of donor and recipient cells is lacking,3, 4, 14, 27, 32, 34, 45 but in these cases, histological evidence of GVHD is presented in the context of symptoms consistent with GVHD.…”

Section: Diagnosismentioning

confidence: 84%

“…We used the terms “graft‐vs.‐host disease” and “liver transplantation.” A secondary search was then performed to include references cited in the articles obtained on the initial search. Including the patients from our experience, a total of 78 cases of GVHD in liver transplant patients were identified 1–46. The incidence of GVHD is unknown, but on the basis of our experience with 5 cases in 1,675 transplants and other reports in the literature, it is thought to be <1%.…”

Section: Literature Reviewmentioning

confidence: 99%

“…There have been 35 adult patients reported to have been treated with these agents for GVHD after OLT, including 4 patients at our center 2, 3, 5, 6, 8, 12, 16, 18, 22, 24–26, 28, 29, 32, 35, 38, 39, 42, 46. Of these, only 5 patients were reported to be alive, all >9 months after transplantation 3, 5, 16, 26, 38. Two of the patients died of posttransplantation lymphoproliferative disease,6, 32 a complication related to high levels of immunosuppression.…”

Section: Treatment Of Gvhdmentioning

confidence: 99%

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Graft vs. host disease after liver transplantation: A new approach is needed

et al. 2007

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Graft-vs.-host disease (GVHD) is a rare, serious complication of orthotopic liver transplantation (OLT). We have treated 5 patients to date with GVHD after OLT. A total of 78 patients worldwide have been reported to have experienced this complication. The means by which GVHD after OLT has been managed is guided by experience with the more common GVHD that occurs after stem cell transplantation. However, despite the use of various treatment modalities, the mortality of GVHD after OLT remains high. This case series and review of the literature demonstrates that successful resolution of GVHD after OLT cannot be expected with the use of those modalities that have been tried to date. It is imperative that new treatments be applied to GVHD after OLT in order to improve the prognosis of patients with this diagnosis.

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Section: Diagnosismentioning

confidence: 84%

Section: Literature Reviewmentioning

confidence: 99%

Section: Treatment Of Gvhdmentioning

confidence: 99%

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Graft vs. host disease after liver transplantation: A new approach is needed

et al. 2007

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“…The PubMed literature search for occurrences of GVHD following adult human liver transplantation yielded 37 reports on 67 different liver transplant recipients2–5, 8–40 A total of 28 of the reports reviewed a single patient; the largest report reviewed 13 patients. The most frequent diagnosis in patients reported to develop GVHD following liver transplantation was alcoholic liver disease (ALD) (28.4%) (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Recipient and donor factors influence the incidence of graft-vs.-host disease in liver transplant patients

et al. 2007

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Acute cellular graft-vs.-host disease (GVHD) following liver transplantation has an incidence of 1 to 2% and a mortality rate of 85%. Our aim was to identify a patient population at high risk for developing GVHD using a large clinical database to study both recipient and donor factors. We compared our liver transplant patients who developed GVHD to those that did not for recipient and donor factors and combinations of factors. For 2003-2004 we had 205 first-time liver transplant patients surviving >30 days. From this group, 4 (1.9%) developed GVHD. Compared to the control group, there were no significant differences in recipient age, recipient gender, donor age, donor gender, total ischemia time, donor-recipient human leukocyte antigen (HLA) mismatch, or donor-recipient age difference. Percentages of liver disease etiologies among the patients who developed GVHD were as follows: 16% (1/6) autoimmune hepatitis (AIH) (P = 0.003), 5.6% (3/54) alcoholic liver disease (ALD) (P = 0.057), and 7.1% (3/42) hepatocellular carcinoma (HCC) (P = 0.026). The incidence of GVHD in patients with glucose intolerance (either Type I or Type II diabetes mellitus [DM]) was significant (P = 0.022). Focusing on patients only with high-risk factors for GVHD during the years 2003-2005, we had 19 such patients. Four of these high-risk patients developed GVHD. Three of these 4 patients had received a donor liver with steatosis of degree >or=mild compared to only 2 of the 15 high-risk patients who did not develop GVHD (P = 0.037). In conclusion, we have identified liver transplant patients with AIH or the combination of ALD, HCC, and glucose intolerance who receive a steatotic donor liver as being at high risk for developing GVHD.

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“…These reports show the inadequacy of corticosteroids and immunosuppressants for GVHD treatment. However successful treatment of GVHD in second liver transplant patient with immunosuppression has also been reported [62]. Recently with antithymocyte globulin, significantly lower rate of chronic GVHD after allogenic transplant has been reported [63].…”

Section: Existing Treatment Modalities For Post Olt-gvhdmentioning

confidence: 99%

Immunological basis for treatment of graft versus host disease after liver transplant

Rai

Dietz

Agrawal

2016

Expert Review of Clinical Immunology

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Summary Graft versus host disease (GVHD) after liver transplant, although a rare disease, has a very high mortality rate. GVHD occurs due to immunoreactions caused by donor T lymphocytes and host cell surface antigens resulting in proliferation and clonal expansion of T lymphocyte. Migration of effector cells, including macrophages, NK cells and cytotoxic T lymphocyte, to the target organs such as skin, intestine and bone marrow results in skin rashes, diarrhea and bone marrow depression. GVHD is diagnosed by clinical symptoms, histopathological findings and by the presence of chimerism. The delayed diagnosis, opportunistic infections and lack of definitive treatment of post orthotopic liver transplant (OLT)-GVHD results in sepsis and multi-organ failure leading to very low survival rates. In this review, we have focused on early diagnosis and critically discuss novel treatment modalities to decrease the incidence of GVHD.

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Successful treatment of Graft-vs-Host disease after a second liver transplant

Cited by 17 publications

References 8 publications

Graft vs. host disease after liver transplantation: A new approach is needed

Graft vs. host disease after liver transplantation: A new approach is needed

Recipient and donor factors influence the incidence of graft-vs.-host disease in liver transplant patients

Immunological basis for treatment of graft versus host disease after liver transplant

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