Graft‐versus‐host disease after orthotopic liver transplantation: multivariate analysis of risk factors

Abstract

Graft-versus-host disease (GVHD) is a rare, fatal complication following orthotopic liver transplantation (OLT). To date, several risk factors have been proposed, but reports on these factors have been inconclusive. This is a retrospective, case-control study of prospectively collected data from 2775 OLTs performed at our institution. Eight cases of GVHD after OLT were diagnosed on the basis of the patient's clinical characteristics, and the findings were confirmed with skin and colonic biopsies. Each case was matched to three controls based on the diagnosis of liver disease, recipient's age, and blood group. Univariate and multivariate analyses were performed to identify risk factors associated with the development of GVHD after OLT. The univariate and multivariate analyses identified two main risk factors associated with development of GVHD in OLT recipients, a difference between recipient and donor age of >20 yr, and any human leukocyte antigen class I matches. Taking these two risk factors into consideration while matching prospective donors and recipients may reduce further incidence of GVHD in OLT patients. However, further studies are recommended to validate these findings.

Tropheryma whipplei infection (Whipple's disease) in a patient after liver transplantation

“…This case is unique, as the first report of WD in a liver transplant patient and remarkable as only the fourth report of WD in a solid organ transplant patient (Table 1; [6][7][8]. The development of GVHD after OLT is also unusual, with an incidence of only 0.1-2% (13,14). The patient's unfortunate death is consistent with known mortality rates of GVHD after OLT approaching 90%.…”

Graft Versus Host Disease After Liver Transplantation in Adults

“…Additional risk factors reported in the literature include donor-recipient age difference greater than 20 years, younger donor age, any HLA class I match, and glucose intolerance. 2, 25 Based on our results, GVHD may occur more frequently in patients transplanted for HCC and less frequently in patients transplanted for hepatitis C. Immune dysregulation plays a major role in the pathogenesis of HCC. Alterations in innate or adaptive immunity, for example a decrease in the CD4+ T lymphocyte function due to chronic inflammation (alcoholic or non-alcoholic steatohepatitis), chronic infection (viral hepatitis), or suppression of immunity (cirrhosis), may tolerance to tumor antigen and promote the development of HCC.…”

Graft-versus-host disease of the central nervous system after liver transplantation: A rare complication

“…The treatment of GVHD has hinged on 2 schools of thought, those being increasing or decreasing of immunosuppression and immunomodulation. Reported treatment modalities have included corticosteroids, withdrawal of immunosuppression, use of anti‐thymocyte globulin or alemtuzumab (Campath), other immunomodulatory drugs such as etanercept, and extracorporeal photopheresis . A recent review of literature involved 34 patients (not involving LT recipients) with CNS‐GVHD who were treated with immunosuppressive therapy, including corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, calcineurin inhibitors, mycophenolic acid, methotrexate, and etoposide, with 10 achieving complete and 15 more achieving partial responses .…”