Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9255-9268
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9255
Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases
Min Tian, Yi Lyu, Bo Wang, Chang Liu, Liang Yu, Jian-Hua Shi, Xue-Min Liu, Xiao-Gang Zhang, Kun Guo, Yu Li, Liang-Shuo Hu
Min Tian, Yi Lyu, Bo Wang, Chang Liu, Liang Yu, Jian-Hua Shi, Xue-Min Liu, Xiao-Gang Zhang, Kun Guo, Yu Li, Liang-Shuo Hu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Tian M, Shi JH, Guo K, Li Y and Hu LS prepared and collected the case data; Lyu Y, Wang B, Liu C, Liu XM, Yu L and Zhang XG analyzed the diagnosis and treatment of the case, and summarized the experience of diagnosis and treatment; Tian M reviewed the literature and was responsible for drafting the manuscript; and all authors gave final approval for the version to be submitted.
Supported by The National Natural Science Foundation of China, No. 81870445; Scientific Research Project of Military Healthcare, No. BZZ19J004.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts 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: Bo Wang, MD, PhD, Chief Doctor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China. bobwang75@sina.com
Received: May 27, 2021
Peer-review started: May 27, 2021
First decision: June 24, 2021
Revised: July 6, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 26, 2021
Abstract
BACKGROUND

Graft-versus-host disease (GVHD) following liver transplantation (LT) is an unpredictable complication with poor outcome. However, consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking. The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD (aGVHD) following LT and reviewed the pertinent literature.

CASE SUMMARY

Between January 1st, 2000 and December 31st, 2020, a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University. Six recipients developed aGVHD with clinical symptoms of fever, rash, diarrhea, and pancytopenia. The incidence of aGVHD was 0.57%. The median time from LT to the clinical presentation of aGVHD was 22.17 d. The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d. All six cases underwent treatment of immunosuppressant adjustment, corticosteroids, human normal immunoglobulin, and antithymocyte globulin/IL-2 antagonists. Despite intensive treatment strategies, 4 patients were deceased due to sepsis, multiple organ failure, and cerebral hemorrhage. The remaining two cases were discharged as treatment successfully. However, one died because of tuberculosis infection on the 6th month of follow-up, the other one was alive healthy during 30 mo of follow-up.

CONCLUSION

The rapid diagnosis of aGVHD is mainly based on the time from the first symptom, histopathological features, and the donor T-lymphocyte chimerism. Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD. Moreover, gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.

Keywords: Graft-versus-host disease, Liver transplantation, Donor T-lymphocytes chimerism, Gut microbiota, Donor-targeted serotherapy, Case report

Core Tip: Acute graft-versus-host disease (aGVHD) is rare after liver transplantation (LT) with an incidence rate of 0.57% and the high mortality (up to 83.33%), which poses a critical challenge to our hospital. The diagnosis of aGVHD mainly depends on clinical symptoms, laboratory examinations especially donor T-lymphocytes chimerism analysis and histopathological. The larger the age distribution and the earlier the first symptoms, it is herald that the more rapid the progression in post-LT aGVHD. The most appear steroid-resistant in post-LT aGVHD. Thus, lower the dose of the corticosteroids, improved antibiotic stewardship, Particularly, gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.