Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases

Table 1 Demographic and some characteristics of six liver transplantation patients with acute graft-versus-host disease

Patients	Recipient age	Recipient sex	Etiology	LT type	Date of OLT	Recipient blood type	Donor blood type	Donor age	Age disparity donor-recipient
Case 1	64	Male	HCC, liver cirrhosis	OLT	2003	B	B	43	21
Case 2	59	Male	HBV, liver cirrhosis	OLT	2006	A	A	50	9
Case 3	53	Male	HCC, HBV, liver cirrhosis	OLT	2016	A	A	51	2
Case 4	63	Male	HCC, HBV, OLT	OLT	2018	O	O	31	32
Case 5	40	Male	HBV, liver cirrhosis	OLT	2018	B	B	46	6
Case 6	64	Male	HBV, liver cirrhosis	OLT	2019	B	B	52	12

LT: Liver transplantation; OLT: Orthotopic liver transplantation; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma.

Table 2 Main clinical characteristics of six liver transplantation patients with acute graft-versus-host disease

Patients	Initial symptom	Involved systems	From LT to GVHD (d)	Diagnostic tools	From LT to biopsy(d)	From GVHD to diagnosis(d)	Skin biopsy	GVHD related death	Ferritin level (ng/mL)	Survival day	Mortality cause
Case 1	Fever	Skin, GI, BM	15	Skin biopsy, bone marrow smear	24	9	Grade II	Yes	-	31	Cerebral hemorrhage
Case 2	Pancytopenia	Skin, BM	28	Skin biopsy, bone marrow smear	32	4	Grade II	No	-	180	Tuberculosis
Case 3	Fever	Skin, GI, BM	24	Skin biopsy, bone marrow smear	34	10	Grade II	Yes	-	51	Sepsis
Case 4	Fever	Skin, BM, CNS	17	Skin biopsy	19	2	Grade III	Yes	31527	21	Sepsis
Case 5	Fever	Skin, GI, BM	31	Skin biopsy, bone marrow smear	38	7	Grade II	No	-	Alive	-
Case 6	Fever	Skin, GI, BM	18	Skin biopsy	31	13	Grade III	Yes	-	45	Sepsis

LT: Liver transplantation; GVHD: Graft-versus-host disease; GI: Gastrointestinal; BM: Bone marrow.

Table 3 The treatment and prognosis of six graft-versus-host disease patients

Patients	Methylprednisolone	Immunosuppressant					IVIG	CRRT	G-CSF/GM-CSF
		Tacrolimus	Cyclosporin	Basiliximab/Zenapax	TNF-α inhibitor	ATG
Case 1	10 mg/kg/d	+	-	Zenapax (2 doses)	-	-	+	-	+
Case 2	10 mg/kg/d	-	↓	-	-	-	+	-	+
Case 3	8 mg/kg/d	-	↓	-	-	50 mg/d, 2 d	+	-	+
Case 4	10 mg/kg/d	↓	-	-	Infliximab, 300 mg/d, 1 d	-	+	+	+
Case 5	7 mg/kg/d	+	-	-	-	-	+	-	+
Case 6	8 mg/kg/d	+	-	Basiliximab (2 doses)	-	-	+	-	+

TNF-α: Tumor necrosis factor-alpha; IVIG: Human normal immunoglobulin; CRRT: Continuous renal replacement therapy; G-CSF: Granulocyte colony-stimulating factor; GM-CSF: Granulocyte-macrophage colony-stimulating factor.