Temporary Cessation of Immunosuppression for Infection May Contribute to the Development of Graft-vs-Host Disease After ABO-Incompatible Living Donor Liver Transplantation: A Case Report

Kim, Keun Ju; Lee, Tae Beom; Yang, Kwangho; Ryu, Je Ho; Choi, Byung Hyun; Lee, Hyunji; Lee, Sun Min; Kim, In-Suk

doi:10.1016/j.transproceed.2019.07.008

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…On POD 52, although diarrhea was ameliorated and skin rash did not become worse, there was no improvement in pancytopenia due to systemic infection. On POD 90, the patient's condition deteriorated progressively with septicemia, pancytopenia, and subsequently multi-organ failure, which resulted in death [13].…”

Section: Case Report Of Graft-versus-host Disease After Abo-incompati...mentioning

confidence: 99%

Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Park

Chung

2022

Ann Liver Transplant

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Graft-versus-host disease (GVHD) occurs when donor lymphocytes recognize recipient cell surface antigens as foreign and react against them. Although GVHD is rare, it is a life-threatening complication. Following liver transplantation (LT), the incidence of GVHD is estimated to be 0.1% to 2%. However, more than 50% of affected patients have died. Living donor LT (LDLT) has a special risk of GVHD because implicating human leukocyte antigen (HLA) matching status between recipients and close-relative living donors. Therefore, we reviewed Korean GVHD cases following LDLT to identify LDLT-oriented characteristics of GVHD. This study included one case from each of three centers and three cases from one high-volume center. One-way donor-recipient HLA match was identified by HLA typing for donor and recipient. Of these six cases of LDLT diagnosed with GVHD, all patients died due to GVHD and its associated complications. In conclusion, post-LT GVHD is a fatal complication despite aggressive treatment approaches. Preventive measures, early diagnosis, early initiation of treatment protocols, prophylactic treatment, and appropriate palliative care are necessary to achieve success against GVHD. Further studies should be performed to reveal the mechanisms of GVHD and improve outcomes of patients who develop GVHD following LT.

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Section: Case Report Of Graft-versus-host Disease After Abo-incompati...mentioning

confidence: 99%

Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Park

Chung

2022

Ann Liver Transplant

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Immunosuppressants/rituximab

2019

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The Consequences of HLA Screening in the Prevention of Graft‐Versus‐Host Disease in Living Donor Liver Transplantation

Ercan,

Durmaz,

Kaymakoğlu

et al. 2024

Pediatric Transplantation

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AimsTo study the effects of routine HLA screening and the policy of avoiding donor‐dominant one‐way HLA match to prevent graft‐versus‐host disease (GVHD) after living donor liver transplantation (LDLT).Patients and MethodsThe records of potential living liver donors and recipients who attended our center between 2007 and 2018 were reviewed retrospectively.ResultsOf the 149 patients who underwent LDLT and survived longer than 3 months, two developed GVHD despite our strict policy. The first patient presented with grade II GVHD limited to the skin. She was treated successfully by briefly discontinuing immunosuppression and switching to everolimus. In the second case, the policy had been relaxed due to the availability of a single donor for ABO‐incompatible transplantation without any intervention to decrease anti‐A antibody levels (special case: A2 to O). Nevertheless, the patient presented with grade I GVHD limited to skin and was treated successfully by adding oral methylprednisolone to tacrolimus and mycophenolate mofetil. To the best of our information, this is the second reported case who recovered from GVHD after LDLT from a donor, homozygous at HLA A, B and DR and a recipient, heterozygous for all. Sixteen potential donors (1.2% of all candidates) of 14 recipients were disqualified solely on the basis of the HLA results; five of these patients died due to unavailability of another donor.ConclusionThe results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after LDLT.

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Temporary Cessation of Immunosuppression for Infection May Contribute to the Development of Graft-vs-Host Disease After ABO-Incompatible Living Donor Liver Transplantation: A Case Report

Cited by 4 publications

References 23 publications

Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Immunosuppressants/rituximab

The Consequences of HLA Screening in the Prevention of Graft‐Versus‐Host Disease in Living Donor Liver Transplantation

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