The Experience Of The Diagnosis And Treatment Of Graft-versus-host Disease After Liver Transplantation In 6 Cases

Background Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is an uncommon but devastating complication with mortality rates over 80%. A firm diagnosis of GVHD is difficult because the clinical traid of skin rash, bone marrow depression and diarrhea can be indistinguishable from drug reaction or viral infection, and the treatment is controversial. We therefore investigated the prognostic factors and clinical data, and summarized the clinical experience in diagnosis and treatment of GVHD after OLT.Methods Six of 380 recipients undergone OLT developed GVHD (5 acute GVHD and 1 chronic GVHD ) from Apr. 1993 to Nov. 2004. The 6 recipients' clinical courses and results of laboratory tests were recorded. The diagnosis of GVHDdepended on clinical manifestations, skin biopsy. HLA matching, and PCR-STR. GVHD was treated via immunosuppressants in partnership with methylprednisolone. anti-thymocyte globulin (ATG). and intravenous immunoglobulin (IVIG).Results The 5 acute GVHD recipients developed fever, skin rash, diarrhea, and pancytopenia within 3 to 8 weeks after OLT. Among them, 3 had digestive tract hemorrhage and 3 bone marrow depression. Their liver functions were normal, and CMV antigen (pp65) and EBV antibody (IgM) were negative. The chronic GVHD recipient had lichen planus-like symptom on all his fingers at month 7 after OLT. His fungus and bacteria detections were negative. The early 2 recipients were diagnosed as having GVHD by clinical manifestations and the later 4 patients by skin biopsy and HLA matching. One female recipient had the donor's Y chromosome microchimerism detected by PCR-STR. Two recipients (1 acute GVHD and 1 chronic GVHD) with successful treatment have been surviving for 6 and 24 months, respectively. The 3 recipients with bone marrow depression died from infection, alimentary tract bleeding, and multiple organ failure. The rest one died in an accident after successful treatment.Conclusions GVHD is not a rare complication with misdiagnosed easily and pessimistic outcomes after liver transplantation. Acute GVHD can cause high mortality due to bone marrow depression, while chronic GVHD may have good prognosis. Areasonable regimen can be to reduce immunosuppressants as applying high dose of methylprednisolone and IVIG..