Journal article
Graft versus Host Disease After Liver Transplantation in Adults: A Case series, Review of Literature, and an Approach to Management
Transplantation, Vol.100(12), pp.2661-2670
12/2016
DOI: 10.1097/TP.0000000000001406
PMCID: PMC5118135
PMID: 27495762
Abstract
Background: Graft-versus-host-disease (GVHD) after liver transplantation (LT) is a deadly complication with very limited data on risk factors, diagnosis and management. We report a case series and a comprehensive review of the literature.
Methods: Data were systematically extracted from reports of GVHD after LT, and from the United Network for Organ Sharing database. Group comparisons were performed.
Results: One hundred fifty-six adult patients with GVHD after LT have been reported. Median time to GVHD onset was 28 days. Clinical features were skin rash (92%), pancytopenia (78%), and diarrhea (65%). Six-month mortality with GVHD after LT was 73%. Sepsis was the most common cause of death (60%). Enterobacter bacteremia, invasive aspergillosis, and disseminated Candida infections were frequently reported. Recipient age over 50 years is a risk factor for GVHD after LT. Hepatocellular carcinoma was overrepresented, whereas chronic hepatitis C was underrepresented, in reported United States GVHD cases relative to all United Network for Organ Sharing database LT cases. Mortality rate with treatment of GVHD after LT was 84% with high-dose steroids alone, 75% to 100% with regimens using dose increases of calcineurin inhibitors, and 55% with IL-2 antagonists. Mortality was 25% in small case series using the CD2-blocker alefacept or TNF-α antagonists.
Conclusions: Age older than 50 years and hepatocellular carcinoma appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and calcineurin inhibitors are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diagnostic algorithm to assist clinicians in managing adults with GVHD after LT.
Details
- Title: Subtitle
- Graft versus Host Disease After Liver Transplantation in Adults: A Case series, Review of Literature, and an Approach to Management
- Creators
- Arvind Rangarajan Murali - Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASubhash Chandra - Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAZoe Stewart - Department of Surgery, Division of Transplantation & Hepatobiliary Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USABruce R Blazar - Division of Blood and Bone Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota, USAUmar Farooq - Division of Hematology and Oncology, Bone Marrow Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAM Nedim Ince - Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAJeffrey Dunkelberg - Department of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.100(12), pp.2661-2670
- DOI
- 10.1097/TP.0000000000001406
- PMID
- 27495762
- PMCID
- PMC5118135
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Language
- English
- Date published
- 12/2016
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984094565502771
Metrics
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