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Journal of Hematology & Oncology
Published in: Journal of Hematology & Oncology 1/2012

Open Access 01-12-2012 | Review

Acute graft versus host disease after orthotopic liver transplantation

Authors: Inga Mandac Rogulj, Joachim Deeg, Stephanie J Lee

Published in: Journal of Hematology & Oncology | Issue 1/2012

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Abstract

Graft versus host disease (GVHD) is an uncommon complication after orthotopic liver transplantation (OLT) with an incidence of 0.1–2%, but an 80–100% mortality rate. Patients can present with skin rashes, diarrhea, and bone marrow aplasia between two to eight weeks after OLT. Diagnosis of GVHD is made based on clinical and histologic evidence, supported by chimerism studies showing donor HLA alleles in the recipient bone marrow or blood. Several therapeutic approaches have been used for the management of GVHD after OLT including increased immunosuppression, decreased immunosuppression, and cellular therapies. However, success rates have been low, and new approaches are needed.
Literature
1.
Jain A, Reyes J, Kashyap R: Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg. 2000, 232 (4): 490-10.1097/00000658-200010000-00004.PubMedCentralCrossRefPubMed
2.
Wu G, Selvaggi G, Nishida S: Graft-versus-host disease after intestinal and multivisceral transplantation. Transplantation. 2011, 91 (2): 219-10.1097/TP.0b013e3181ff86ec.CrossRefPubMed
3.
Schroeder ML: Transfusion-associated graft-versus-host disease. Brit J Hematol. 2002, 117: 275-10.1046/j.1365-2141.2002.03450.x.CrossRef
4.
Chen XB, Yang J, Xu MQ, Wen TF, Yan LN: Unsuccessful treatment of four patients with acute graft-vs-host disease after liver transplantation. World J Gastroenterol. 2012, 18 (1): 84-10.3748/wjg.v18.i1.84.PubMedCentralCrossRefPubMed
5.
Perri R, Assi M, Talwalkar J: Graft vs. host disease after liver transplantation: a new approach is needed. Liver Transpl. 2007, 13 (8): 1092-10.1002/lt.21203.CrossRefPubMed
6.
Burdick JF, Vogelsang GB, Smith WJ: Severe graft-versus-host disease in a liver transplant recipient. N Engl J Med. 1988, 318 (11): 689-10.1056/NEJM198803173181107.CrossRefPubMed
7.
Moody MN, Kazakevich N, Smith JR: Sweat the small stuff: the importance of clinicalpathologic correlation in cutaneous GVHD following orthotopic liver transplant. Arch Dermatol. 2011, 147 (11): 1345-10.1001/archdermatol.2011.331.CrossRefPubMed
8.
Nguyen J, Tetzlaff MT, Zhang PJ, Xu X, Hexner E, Rosenbach M: Fluorescent in situ hybridization of a skin biopsy: an adjunctive tool to support a diagnosis of graft-versus-host disease. J Am Acad Dermatol. 2011, 64 (6): e113-10.1016/j.jaad.2010.09.716.CrossRefPubMed
9.
Post GR, Black JS, Cortes GY, Pollack RB, Wolff DJ, Lazarchick J: The utility of fluorescence in situ hybridization (FISH) analysis in diagnosing graft versus host disease following orthotopic liver transplant. Ann Clin Lab Sci. 2011, 41 (2): 188-PubMed
10.
Meves A, el-Azhary RA, Talwalkar JA: Acute graft-versus-host disease after liver transplantation diagnosed by fluorescent in situ hybridization testing of skin biopsy specimens. J Am Acad Dermatol. 2006, 55 (4): 642-10.1016/j.jaad.2006.04.073.CrossRefPubMed
11.
Schlitt HJ, Raddatz G, Steinhoff G, Wonigeit K, Pichlmayr R: Passenger lymphocytes in human liver allografts and their potential role after transplantation. Transplantation. 1993, 56 (4): 951-10.1097/00007890-199310000-00033.CrossRefPubMed
12.
Schoniger-Hekele M, Muller C, Kramer L: Graft versus host disease after orthotopic liver transplantation documented by analysis of short tandem repeat polymorphisms. Digestion. 2006, 74 (3–4): 169-CrossRefPubMed
13.
Stachel D, Schmid I, Lang T, Haas RJ, Otte JB: Double bone marrow transplantation for severe aplastic anemia after orthotopic liver transplantation: implications for clinical management and immune tolerance. Transpl Int. 2002, 15 (1): 39-10.1111/j.1432-2277.2002.tb00096.x.CrossRefPubMed
14.
Norris S, Collins C, Doherty DG: Resident human hepatic lymphocytes are phenotypically different from circulating lymphocytes. J Hepatol. 1998, 28 (1): 84-10.1016/S0168-8278(98)80206-7.CrossRefPubMed
15.
Collins RH, Anastasi J, Terstappen LW: Brief report: donor-derived long-term multilineage hematopoiesis in a liver-transplant recipient. N Engl J Med. 1993, 328 (11): 762-10.1056/NEJM199303183281104.CrossRefPubMed
16.
Taylor AL, Gibbs P, Sudhindran S: Monitoring systemic donor lymphocyte macrochimerism to aid the diagnosis of graft-versus-host disease after liver transplantation. Transplantation. 2004, 77 (3): 441-10.1097/01.TP.0000103721.29729.FE.CrossRefPubMed
17.
Hahn AB, Baliga P: Rapid method for the analysis of peripheral chimerism in suspected graftversus-host disease after liver transplantation. Liver Transpl. 2000, 6 (2): 180-PubMed
18.
Domiati-Saad R, Klintmalm GB, Netto G, Agura ED, Chinnakotla S, Smith DM: Acute graft versus host disease after liver transplantation: patterns of lymphocyte chimerism. Am J Transplant. 2005, 5 (12): 2968-10.1111/j.1600-6143.2005.01110.x.CrossRefPubMed
19.
Soejima Y, Shimada M, Suehiro T: Graft-versus-host disease following living donor liver transplantation. Liver Transpl. 2004, 10 (3): 460-10.1002/lt.20101.CrossRefPubMed
20.
Kamei H, Oike F, Fujimoto Y, Yamamoto H, Tanaka K, Kiuchi T: Fatal graft-versus-host disease after living donor liver transplantation: differential impact of donor-dominant one-way HLA matching. Liver Transpl. 2006, 12 (1): 140-10.1002/lt.20573.CrossRefPubMed
21.
Key T, Taylor CJ, Bradley JA, Taylor AL: Recipients who receive a human leukocyte antigen-B compatible cadaveric liver allograft are at high risk of developing acute graft-versus-host disease. Transplantation. 2004, 78 (12): 1809-10.1097/01.TP.0000145523.08548.48.CrossRefPubMed
22.
Chan EY, Larson AM, Gernsheimer TB: Recipient and donor factors influence the incidence of graft-vs.-host disease in liver transplant patients. Liver Transpl. 2007, 13 (4): 516-10.1002/lt.21082.CrossRefPubMed
23.
Heaton ND, Reece AS, Tan KC: Graft-versus-host disease following liver transplantation. J R Soc Med. 1992, 85 (6): 313-PubMedCentralPubMed
24.
Pollack MS, Speeg KV, Callander NS: Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis. Hum Immunol. 2005, 66 (1): 28-10.1016/j.humimm.2004.09.014.CrossRefPubMed
25.
Hagglund H, Winiarski J, Ringden O, Sparrelid E, Ericzon BG: Successful allogeneic bone marrow transplantation in a 2.5-year-old boy with ongoing cytomegalovirus viremia and severe aplastic anemia after orthotopic liver transplantation for non-A, non-B, non-C hepatitis. Transplantation. 1997, 64 (8): 1207-PubMed
26.
Kawahara K, Storb R, Sanders J, Petersen FB: Successful allogeneic bone marrow transplantation in a 6.5-year-old male for severe aplastic anemia complicating orthotopic liver transplantation for fulminant non-A-non-B hepatitis. Blood. 1991, 78 (4): 1140-PubMed
27.
Perkins JL, Neglia JP, Ramsay NK, Davies SM: Successful bone marrow transplantation for severe aplastic anemia following orthotopic liver transplantation: long-term follow-up and outcome. Bone Marrow Transplant. 2001, 28 (5): 523-10.1038/sj.bmt.1703177.CrossRefPubMed
28.
Trede NS, Warwick AB, Rosoff PM, Rohrer R, Bierer BE, Guinan E: Tacrolimus (FK506) in allogeneic bone marrow transplantation for severe aplastic anemia following orthotopic liver transplantation. Bone Marrow Transplant. 1997, 20 (3): 257-10.1038/sj.bmt.1700872.CrossRefPubMed
29.
Yoshimi A, Nannya Y, Ueda K: Successful hematopoietic stem cell transplantation from an HLA-identical sibling in a patient with aplastic anemia after HLA-haploidentical living related liver transplantation for fulminant hepatitis. Biol Blood Marrow Transplant. 2009, 15 (3): 389-10.1016/j.bbmt.2008.11.021.CrossRefPubMed
30.
Schmuth M, Vogel W, Weinlich G, Margreiter R, Fritsch P, Sepp N: Cutaneous lesions as the presenting sign of acute graft-versus-host disease following liver transplantation. Br J Dermatol. 1999, 141 (5): 901-10.1046/j.1365-2133.1999.03166.x.CrossRefPubMed
31.
Piton G, Larosa F, Minello A: Infliximab treatment for steroid-refractory acute graftversus-host disease after orthotopic liver transplantation: a case report. Liver Transpl. 2009, 15 (7): 682-10.1002/lt.21793.CrossRefPubMed
32.
Kriss M, Feliciano J, Fryer J, Mehta J, Levitsky J: Haploidentical hematopoietic stem cell transplantation for graft-versus-host disease after liver transplantation. Blood. 2011, 118 (12): 3448-10.1182/blood-2011-05-353714.CrossRefPubMed
33.
Wisecarver JL, Cattral MS, Langnas AN: Transfusion-induced graft-versus-host disease after liver transplantation. Documentation using polymerase chain reaction with HLA-DR sequence-specific primers. Transplantation. 1994, 58 (3): 269-CrossRefPubMed
34.
Au WY, Ma SK, Kwong YL: Graft-versus-host disease after liver transplantation: documentation by fluorescent in situ hybridisation and human leucocyte antigen typing. Clin Transplant. 2000, 14 (2): 174-10.1034/j.1399-0012.2000.140213.x.CrossRefPubMed
35.
Smith DM, Agura E, Netto G: Liver transplant-associated graft-versus-host disease. Transplantation. 2003, 75 (1): 118-10.1097/00007890-200301150-00022.CrossRefPubMed
36.
Aziz H, Trigo P, Lendoire J: Successful treatment of graft-vs-host disease after a second liver transplant. Transplant Proc. 1998, 30 (6): 2891-10.1016/S0041-1345(98)00857-4.CrossRefPubMed
37.
Lehner F, Becker T, Sybrecht L: Successful outcome of acute graft-versus-host disease in a liver allograft recipient by withdrawal of immunosuppression. Transplantation. 2002, 73 (2): 307-10.1097/00007890-200201270-00030.CrossRefPubMed
38.
Schappi MG, Belli DC, Rimensberger PC: Fatal GvHD as a complication of liver transplantation for undetermined fulminant hepatic failure and associated aplastic anemia. Liver Transpl. 2006, 12 (11): 1693-10.1002/lt.20916.CrossRefPubMed
39.
Ghali MP, Talwalkar JA, Moore SB, Hogan WJ, Menon KV, Rosen CB: Acute graft-versus-host disease after liver transplantation. Transplantation. 2007, 83 (3): 365-CrossRefPubMed
40.
Chinnakotla S, Smith DM, Domiati-Saad R: Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management. Liver Transpl. 2007, 13 (1): 157-10.1002/lt.20982.CrossRefPubMed
41.
Lu Y, Wu LQ, Zhang BY, Cao JY: Graft-versus-host disease after liver transplantation: successful treatment of a case. Transplant Proc. 2008, 40 (10): 3784-10.1016/j.transproceed.2008.03.164.CrossRefPubMed
42.
Kohler S, Pascher A, Junge G: Graft versus host disease after liver transplantation - a single center experience and review of literature. Transpl Int. 2008, 21 (5): 441-10.1111/j.1432-2277.2007.00625.x.CrossRefPubMed
43.
Stotler CJ, Eghtesad B, Hsi E, Silver B: Rapid resolution of GVHD after orthotopic liver transplantation in a patient treated with alefacept. Blood. 2009, 113 (21): 5365-10.1182/blood-2009-02-207431.CrossRefPubMed
44.
Yuksekkaya HA, Arikan C, Tumgor G, Aksoylar S, Kilic M, Aydogdu S: Late-onset graft-versus host disease after pediatric living-related liver transplantation for Langerhans cell histiocytosis. Pediatr Transplant. 2011, 15 (6): E105-9.PubMed
45.
Shimizu T, Hayashi M, Inoue Y: Acute graft-versus-host disease after living donor liver transplantation with donor-dominant one-way human leukocyte antigen matching at two Loci. Transplantation. 2010, 89 (9): 1164-10.1097/TP.0b013e3181cea646.CrossRefPubMed
46.
Alexander SI, Smith N, Hu M: Chimerism and tolerance in a recipient of a deceased donor liver transplant. N Engl J Med. 2008, 358 (4): 369-10.1056/NEJMoa0707255.CrossRefPubMed
47.
Kuball J, Theobald M, Ferreira EA: Control of organ transplant-associated graft-versushost disease by activated host lymphocyte infusions. Transplantation. 2004, 78 (12): 1774-10.1097/01.TP.0000144183.77279.EC.CrossRefPubMed
48.
Young AL, Leboeuf NR, Tsiouris SJ, Husain S, Grossman ME: Fatal disseminated Acanthamoeba infection in a liver transplant recipient immunocompromised by combination therapies for graft-versus-host disease. Transpl Infect Dis. 2010, 12 (6): 529-10.1111/j.1399-3062.2010.00535.x.CrossRefPubMed
49.
Mawad R, Hsieh A, Damon L: Graft-versus-host disease presenting with pancytopenia after en bloc multiorgan transplantation: case report and literature review. Transplant Proc. 2009, 41 (10): 4431-10.1016/j.transproceed.2009.06.229.CrossRefPubMed
50.
Romagnuolo J, Jewell LD, Kneteman NM, Bain VG: Graft-versus-host disease after liver transplantation complicated by systemic aspergillosis with pancarditis. Can J Gastroenterol. 2000, 14 (7): 637-PubMed
51.
Thin L, Macquillan G, Adams L: Acute graft-versus-host disease after liver transplant: novel use of etanercept and the role of tumor necrosis factor alpha inhibitors. Liver Transpl. 2009, 15 (4): 421-10.1002/lt.21704.CrossRefPubMed
52.
Guo ZY, He XS, Wu LW: Graft-verse-host disease after liver transplantation: a report of two cases and review of literature. World J Gastroenterol. 2008, 14 (6): 974-10.3748/wjg.14.974.PubMedCentralCrossRefPubMed
53.
Rinon M, Maruri N, Arrieta A, Fernandez JR, Ortiz de Urbina J, Garcia Masdevall MD: Selective immunosuppression with daclizumab in liver transplantation with graft-versus-host disease. Transplant Proc. 2002, 34 (1): 109-10.1016/S0041-1345(01)02828-7.CrossRefPubMed
54.
Wang B, Lu Y, Yu L, Liu C, Wu Z, Liu X: Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports. Transplant Proc. 2007, 39 (5): 1696-10.1016/j.transproceed.2007.02.078.CrossRefPubMed
55.
Yashar S, Wu SS, Binder SW, Cotliar J: Acute graft-versus-host disease after pediatric solid organ transplant. J Drugs Dermatol. 2008, 7 (5): 467-PubMed
56.
Sudhindran S, Taylor A, Delriviere L: Treatment of graft-versus-host disease after liver transplantation with basiliximab followed by bowel resection. Am J Transplant. 2003, 3 (8): 1024-10.1034/j.1600-6143.2003.00108.x.CrossRefPubMed
57.
Whalen JG, Jukic DM, English JC: Rash and pancytopenia as initial manifestations of acute graft-versus-host disease after liver transplantation. J Am Acad Dermatol. 2005, 52 (5): 908-10.1016/j.jaad.2005.01.126.CrossRefPubMed
58.
Collins RH, Cooper B, Nikaein A, Klintmalm G, Fay JW: Graft-versus-host disease in a liver transplant recipient. Ann Intern Med. 1992, 116 (5): 391-CrossRefPubMed
59.
Ayala R, Grande S, Albizua E: Long-term follow-up of donor chimerism and tolerance after human liver transplantation. Liver Transpl. 2009, 15 (6): 581-10.1002/lt.21736.CrossRefPubMed
60.
Feng S, Ekong UD, Lobritto SJ: Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants. JAMA. 2012, 307 (3): 283-10.1001/jama.2011.2014.CrossRefPubMed
Metadata
Title
Acute graft versus host disease after orthotopic liver transplantation
Authors
Inga Mandac Rogulj
Joachim Deeg
Stephanie J Lee
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of Hematology & Oncology / Issue 1/2012
Electronic ISSN: 1756-8722
DOI
https://doi.org/10.1186/1756-8722-5-50

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