Xiao JJ, Ma JY, Liao J, Wu D, Lv C, Li HY, Zuo S, Zhu HT, Gu HJ. Fluorescence in situ hybridization-based confirmation of acute graft-vs-host disease diagnosis following liver transplantation: A case report. World J Gastrointest Surg 2021; 13(9): 1102-1109 [PMID: 34621484 DOI: 10.4240/wjgs.v13.i9.1102]
Corresponding Author of This Article
Hua-Jian Gu, MD, Chief Physician, Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, No. 16 Beijing Road, Guiyang 550004, Guizhou Province, China. zhaoyaree@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1102-1109 Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1102
Fluorescence in situ hybridization-based confirmation of acute graft-vs-host disease diagnosis following liver transplantation: A case report
Jing-Jing Xiao, Jin-Yu Ma, Jun Liao, Di Wu, Chao Lv, Hai-Yang Li, Shi Zuo, Hai-Tao Zhu, Hua-Jian Gu
Jing-Jing Xiao, Jin-Yu Ma, Jun Liao, Di Wu, Chao Lv, School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Hai-Yang Li, Shi Zuo, Hai-Tao Zhu, Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Hua-Jian Gu, Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Author contributions: Xiao JJ and Ma JY were the patients’ surgeons and designed the research; Liao J, Wu D, and Lv C reviewed the literature and contributed to the drafting of the manuscript; Li HY and Zhu HT collected the surgical data and recordings; Zuo S processed the operation screenshots; Gu HJ was responsible for language editing and revision of the manuscript and supervised the revision of the manuscript; All authors took part in the final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Jian Gu, MD, Chief Physician, Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, No. 16 Beijing Road, Guiyang 550004, Guizhou Province, China. zhaoyaree@sina.com
Received: March 20, 2021 Peer-review started: March 20, 2021 First decision: June 5, 2021 Revised: June 5, 2021 Accepted: July 20, 2021 Article in press: July 20, 2021 Published online: September 27, 2021
Abstract
BACKGROUND
Although acute graft-vs-host disease (aGvHD) is a rare complication of liver transplantation, it is poorly understood and has an extremely high mortality rate. No standardized diagnostic criteria or treatment regimens currently exist.
CASE SUMMARY
The present study investigated the etiology, diagnosis, and treatment of aGvHD following liver transplantation. Presentation, diagnosis, disease course, histology, and treatment of an aGvHD case are reported, and associated literature is reviewed. A 64-year-old female required LTx due to primary biliary cirrhosis. The donor was a 12-year-old male. Three weeks following liver transplantation, the recipient developed pyrexia, diarrhea, rashes, and antibiotic-unresponsive pancytopenia. Clinical symptoms together with laboratory investigations suggested a diagnosis of aGvHD, which was confirmed via peripheral blood fluorescent in situ hybridization. Donor XY chromosome fluorescent in situ hybridization indicating early chimerism achieved 93% sensitivity in the detection of GvHD. Existing immunosuppressants were discontinued, and high-dose intravenous methylprednisolone was initiated along with antibiotics. While diarrhea resolved, the patient’s general condition continued to deteriorate until demise due to multi-system organ failure at 37 d post-liver transplantation. This case illustrates the life-threatening nature of aGvHD.
CONCLUSION
Herein, we have summarized a post-LTx aGvHD case and reviewed associated literature in order to increase awareness and provide potentially risk-mitigating recommendations.
Core Tip: At present, the risk factors, pathogenesis, optimal treatment, and prognosis associated with acute graft-vs-host disease following liver transplantation are unclear. Currently, the most reliable diagnostic method is specific immunostaining for donor-specific antigens. If the donor is male and the recipient is female, fluorescent in situ hybridization-based detection of the Y chromosome is a diagnostic option. In the present case, acute graft-vs-host disease was confirmed via fluorescent in situ hybridization, demonstrating the presence of male donor DNA.
