Forma aguda da doença enxerto contra o hospedeiro após transplante de fígado. Existe opção terapêutica para as formas refratárias ao tratamento com esteróides?

Abstract

Background: Acute graft-versus-host disease (GVHD) usually occurs by 8 weeks after liver transplantation (LT) usually is an uncommon complication but has both high mortality and major diagnostic challenge in addition most of them are associated with resistance to steroid therapy. Objective: Discuss the pathogenesis, treatment and long-term results of Acute Graft versus Host Disease after Liver Transplantation. Methods: A PubMed search was performed to identify all reported cases of GVHD following LT. The medical subject heading GVHD disease was used in combination with LT, including adults (19 + years) and children. The bibliographies of the articles found though PubMed were then searched for further reports of GVHD. Results: We reviewed 102 cases of acute GVHD, 96 (94.1%) adults and 6 (5.8%) children. After treatment 24 (25%) adults and 3 (50%) children were alive only. As far as the treatment of GVHD is concern the therapy used in adults and in children patients was respectively : anti-thymocyte globulin + prednisolone -19 (19.5%); interleukin-2 receptor blocker -17 (17.5%); OKT3 -12 (12.3%); cyclosporine -9 (9,2% ); others -39 (40.2%) and in children anti-thymocyte globulin -1 (20%); anti-thymocyte globulin + prednisolone -1 (20%); prednisolone -1 (20%); anti-thymocyte globulin + prednisolone + interleukin-2 receptor blocker-1 (20%); not mentioned -1.There was no standard treatment of acute GVHD for both children and adults. Conclusion: Although acute GVHD following LT is rare complication and mortality is still very high, there is no consensus for the treatment of steroid-refractory forms. Further researches are needed to provide new approach for treating effectively such condition.