Graft-versus-host disease as an unusual complication following liver transplant
Libuše Husová1, Hana Jedličková2, Tomáš Ostřížek3, Milan Kuman3, Soňa Štěpánková3, Víta Žampachová4, Petr Němec3, Vladimír Mejzlík5
1 Centrum kardiovaskulární a transplantační chirurgie Brno
2 I. dermatovenerologická klinika LF MU a FNUSA v Brně
3 Centrum kardiovaskulární a transplantační chirurgie, Brno
4 I. patologicko-anatomický ústav, LF MU a FNUSA, Brno
5 Centrum kardiovaskulární a transplantační chirurgie FN U sv. Anny, Brno
417 orthotopic transplants were carried out at the Brno transplant centre between 2 February 1983 and 1 December 2011. Graft-versus-host disease (GVHD) was diagnosed in a single case (0.24%). The authors describe the case of a 59-year-old woman who underwent liver transplant due to secondary biliary cirrhosis following iatrogenic damage of the ductus choledochus during cholecystectomy. Following the liver transplant, the patient developed skin exanthem accompanied by diarrhoea, followed by leukopenia and septic shock development. The GVHD diagnosis was tested by skin biopsy and supported by determining the presence of the proportion of donor cells in the recipient's peripheral blood (chimerism). The treatment involved applying high doses of glucocorticoids, maintaining the lowest possible effective levels of tacrolimus, administering immunoglobulins, anti-CD25 mAbs, and symptomatic therapy (factor stimulating granulocytes, antibiotics and antivirotics). Despite the very complicated course, the patient improved both subjectively and objectively and the GVHD symptoms gradually subsided. However, the condition was accompanied by a distinctive leukopenia with sepsis developed. The above-mentioned therapy resulted in a gradual improvement of both the clinical condition and the laboratory results as well as in the discharge after 77 days from the transplant. However, after another 10 days skin symptoms reoccurred, which subsided again after increasing glucocorticoids and reducing the dose of calcineurin inhibitors. This condition was accompanied by neither leukopenia nor sepsis. The patient had recovered again by the 252nd day after the transplant with heart failure involving bioptically proven viral myocarditis. The patient is now 10 months after the liver transplant without any GVHD clinical symptoms and with good functioning of the liver graft.
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