Fluorescence in situ hybridization-based confirmation of acute graft-vs-host disease diagnosis following liver transplantation: A case report

Table 1 Recipient and donor demographic, clinical, and typing data

Recipient	Donor
Age	64	12
Sex	Female	Male
Primary complaint	PBC	Hypoxic-ischemic encephalopathy
Special history	Low-dose glucocorticoids	NA
Blood group	A	A
HLA	NA	NA

PBC: Primary biliary cirrhosis; HLA: Human leukocyte antigen; NA: Not applicable.

Table 2 Clinical manifestation and treatment timeline

	Manifestations				Drugs
PO day	Temperature (°C)	Skin rash	Diarrhea	Myelosuppression	Tacrolimus (mg/d)	MMF (g/d)	MP	IgG (g/d)	Antibiotics
22	38.3	Palm	2	NA	3	0.25	500	10	Yes
24	38.6	Neck	3	NA	2	0	500	10	Yes
26	38.5	Face	6	Yes	2	0	120	NA	Yes
28	38.2	Trunk	7	Yes	2	0	40	NA	Yes
30	39	> 35%	6	Yes	2	0	20	NA	Yes
32	38.6	> 50%	5	Yes	1.5	0	20	10	Yes
34	38.7	> 55%	4	Yes	1.5	0	20	10	NA
36	Demise

PO: Post-operative; NA: Not applicable; MMF: Two oral formulations of mycophenolate mofetil; MP: Methylprednisolone; IgG: Immunoglobulin G. Antibiotics: Melophenan (1 g every 8 h) + carpophennet (50 mg per day) + vancomycin (0.5 g every 6 h).

Table 3 Post-operative laboratory investigation timeline

Post-operative laboratory investigation timeline
Value/PO day	0	4	8	12	16	20	24	26	30	34	36
AST (U/L)	643	47.6	56	48	64	75	63	56	44	52	74
ALT (U/L)	772	88.1	96	86	107.3	62	59	64	66	71	83
Total bilirubin (mg/dL)	231.4	123.5	119.5	76.9	65.5	23.7	25.8	24.2	35.1	45.6	48.7
Direct bilirubin (mg/dL)	146.1	63.2	59.3	43.2	38.1	13.3	15.6	16.5	24.7	28.5	31.2
Leukocyte count × 109/L	17.5	8.7	12.4	17.3	7.2	6.7	1.3	0.39	0.24	0.12	0.08
Neutrophil %	93	79	86	92	81	80	63	17.9	0	0	0
Hemoglobin (g/L)	89	92	176	113	92	85	75	63	58	53	47
Hematocrit %	42	46	50	32	26.5	23.3	22	17.6	16.5	15.6	14.8
Platelets × 109/L	21	26	44	58	77	73	71	56	47	46	41
Prothrombin time (s)	17.9	19.9	16.5	22.4	13.5	13.1	12.7	13.1	12.8	13.2	13.6
INR	1.82	1.7	1.34	1.98	1.05	1.01	0.97	0.99	0.98	1.02	1.07
Sodium (mmol/L)	147	145	142	139	136	134	143	141	138	139	143
Potassium (mmol/L)	3.8	4.5	3.1	3.4	3.6	3.8	3.9	4.2	4.1	3.9	3.7
Urea (mmol/L)	32.52	29.8	16.42	4.55	4.77	4.46	4.13	3.8	4.17	3.74	4.02
Creatinine (μmol/L)	89.73	85.64	64.59	43.78	58.44	53.76	49.19	46.52	27.26	24.54	30.45
PCT (ng/mL)	5.73	3.86	11.5	5.1	1.86	2.65	2.58	2.45	2.18	3.65	4.53

PO: Post-operative; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International normalized ratio; PCT: Procalcitonin.