Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis

Pollack, Marilyn S.; Speeg, Kermit V; Callander, Natalie S.; Freytes, César O.; Espinoza, Alfredo; Esterl, Robert M.; Abrahamian, Gregory A; Washburn, W. Kenneth; Halff, Glenn A.

doi:10.1016/j.humimm.2004.09.014

Cited by 34 publications

(41 citation statements)

References 6 publications

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“…6 In the present case, the patient was readmitted 3 months after the liver transplant with florid watery diarrhea, skin rash, and palmar erythema, typical signs of GVHD. The diarrhea may have been caused by impaired intestinal absorption because of lymphocyte infiltration and destruction of the intestinal mucosa.…”

Section: Discussionmentioning

confidence: 67%

“…2,5,10 Another method includes antilymphocytic agents such as antithymocyte globulin, antilymphocyte globulin, and monoclonal antilymphocyte agents; although this is an improvement over corticosteroids, survival remains poor. 2,5,6,8 Anti-interleukin-2 receptor antibodies have been used successfully in the treatment of GVHD after liver transplant. 13 However, reports of benefits must be tempered by other reports documenting a lack of efficacy.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Liver Transplant Graft-Versus-Host Disease With Antibodies Against Tumor Necrosis Factor-α

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Li²,

Kratt³

et al. 2012

Exp Clin Transplant

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Acute graft-versus-host disease is uncommon after liver transplant. We recently treated a 60-year-old man with liver transplant for hepatocellular carcinoma. After the primary liver transplant graft did not function, revision liver transplant resulted in excellent function. Subsequently, the patient developed watery diarrhea, systemic inflammatory response syndrome, a skin rash on his limbs and trunk, and palmar erythema. Skin biopsy suggested viral exanthems consistent with cytomegalovirus. Despite treatment for cytomegalovirus, intestinal symptoms worsened. Analysis of peripheral blood with fluorescence-activated cell sorting showed a high proportion of T lymphocytes, with 5% to 10% T cells specific to the second donor, suggestive of graft-versus-host disease. Within 48 hours after beginning therapy with antibodies against tumor necrosis factor-α (infliximab), the skin rash disappeared and endoscopy showed slight improvement of the mucosal regeneration. However, despite antifungal prophylaxis with caspofungin, the patient developed angioinvasive pulmonary aspergillosis and multiple organ failure, and he died. In conclusion, typical clinical symptoms of graftversus-host disease after liver transplant may include skin rash and gastrointestinal symptoms, and diagnosis may be confirmed by histologic examination and testing for blood chimerism. A consensus for the treatment of graft-versus-host disease still is lacking, but tumor necrosis factor-α is an encouraging target for therapy to decrease the symptoms of graft-versus-host disease and enable mucosal regeneration.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Treatment of Liver Transplant Graft-Versus-Host Disease With Antibodies Against Tumor Necrosis Factor-α

Blank

Li²,

Kratt³

et al. 2012

Exp Clin Transplant

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“…Typical histological signs are ulcerations with loss of surface epithelium, crypt destruction and presence of apoptotic cells without viral inclusions in the gastrointestinal tract; and vacuolar degeneration in the basal lamina, dyskeratotic apoptotic cells and infiltration of lymphocytes in the skin (5). We can confirm the diagnosis with chimerism (presence of donor cells) in the blood of the recipient of more than 30% (6).…”

Section: Discussionmentioning

confidence: 85%

Graft versus host disease as a complication after liver transplantation: A rare but serious association

Pérez-Saborido¹,

Asensio-Díaz²,

Barrera-Rebollo³

et al. 2015

Rev Esp Enferm Dig

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“…Finally, although SOT-GVHD typically presents early posttransplant, a case report by Pollack et al of severe late-onset GVHD 8 months after liver SOT illustrates the importance of considering SOT-GVHD in the differential diagnosis any time an SOT recipient presents with unexplained pancytopenia. 38 …”

Section: Gvhd After Sotmentioning

confidence: 99%

“…38,39 Attention to the time of onset of the cytopenia(s) is important, because PLS, GVHD, HPS, and TMA are more likely to occur in first few months after SOT, and PTLD is most common in the first year after SOT. Opportunistic infections, especially viral infections, should always be investigated as a potential precipitating cause of cytopenia(s), either as the direct agent of marrow suppression or as the trigger for HPS or immune cytopenia(s).…”

Section: Evaluation Of Anemia and Cytopenias After Sotmentioning

confidence: 99%

Hematologic Disorders after Solid Organ Transplantation

Smith

2010

Hematology

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The evaluation of hematologic disorders after solid organ transplantation (SOT) must take into account issues unique to the post-transplant setting that influence the development of anemia and single or multi-lineage cytopenias. Attention to the time of onset of cytopenia(s) is important, because the disorders of passenger lymphocyte syndrome, transplant-related thrombotic microangiopathy, hemophagocytic syndrome, and graft-versus-host disease typically occur during the first few months after SOT, and post-transplant lymphoproliferative disorder usually occurs within the first year. Drug-related anemia and cytopenia(s) occur due to a variety of mechanisms, including drug-induced hemolysis and marrow suppression and perturbation of T-cell subsets by the immunosuppressive agents, leading to immune dysregulation and autoimmunity. Viral infections can cause direct suppression of hematopoiesis, and a variety of opportunistic infections can precipitate acquired hemophagocytic syndrome, a frequently lethal systemic inflammatory disorder. Early investigation of pancytopenia by bone marrow biopsy is warranted, because it is often the presenting symptom of one or multiple life-threatening pathologies after SOT, such as graft-versus host disease, post-transplant lymphoproliferative disorder, hemophagocytic syndrome, or severe opportunistic infections, and these entities may have a better prognosis if early interventions are undertaken.

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Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis

Cited by 34 publications

References 6 publications

Treatment of Liver Transplant Graft-Versus-Host Disease With Antibodies Against Tumor Necrosis Factor-α

Treatment of Liver Transplant Graft-Versus-Host Disease With Antibodies Against Tumor Necrosis Factor-α

Graft versus host disease as a complication after liver transplantation: A rare but serious association

Hematologic Disorders after Solid Organ Transplantation

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