Unsuccessful treatment of four patients with acute graft-vs-host disease after liver transplantation

Table 2 Treatment for graft-vs-host disease and outcome

Case	Immunosuppression and supportive therapy	Time of death	Cause of death
1	Increased immunosuppressant (methylprednisolone 500 mg, iv, qd, for 3 d), then CsA and mycophenolate mofetil + G-CSF (0.075 mg, bid, for 11 d) + antibiotics (imipenem/cilastatin sodium, azithromycin, moxifloxacin, meropenem and teicoplanin) + anti-fungal (fluconazole)	POD 34	MOF and sepsis
2	Increased immunosuppressant (methylprednisolone 500 mg, iv, qd, for 2 d), then withdrawal (POD 29) of immunosuppressant + G-CSF (0.075 mg, bid, for 9 d) + IVIG (20 g, qd, for 9 d) + broad spectrum antibiotics (cefuroxime, ceftriaxone and imipenem/cilastatin) + anti-fungal (fluconazole)	POD 38	Gastrointestinal bleeding
3	Increased immunosuppressant (methylprednisolone 500 mg, qd, for 2 d), then withdrawal (POD 29) of immunosuppressant + thymosin α1 (Zadaxin 1.6 mg, qd, for 7 d) + G-CSF (0.075 mg, bid, for 7 d) + broad spectrum antibiotics (cefminox)	POD 35	Gastrointestinal bleeding and sepsis
4	Increased immunosuppressant (methylprednisolone 500 mg, iv, qd, for 2 d), then withdrawal (POD 30) of immunosuppressant + IVIG (20 g, qd, for 7 d) + thymosin α1 (Zadaxin 1.6 mg, qd, for 7 d) + G-CSF (0.075 mg, bid, for 5 d) + broad spectrum antibiotics (cefminox, cefoperazone/sulbactam)	POD 36	Gastrointestinal bleeding and sepsis

CsA: Cyclosporine A; G-CSF: Granulocyte colony-stimulating factor; IVIG: Intravenous immunoglobulin therapy; MOF: Multiple organ failure; POD: Post-operation day.