1
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Huang Y, Wang Y, Chase RC, Yang L. Incidence and risk factors of graft-versus-host disease after liver transplantation: A national study 2010-2020. Hepatol Commun 2023; 7:e0271. [PMID: 37756119 PMCID: PMC10531268 DOI: 10.1097/hc9.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a common complication of hematopoietic cell transplantation, and its incidence is low in liver transplantation (LT). Estimating the incidence of GVHD after LT is challenging due to the paucity of available data from the United Network for Organ Sharing. This is the first national analysis of the incidence and risk factors of GVHD after LT. METHODS This retrospective cohort study used the National Readmission Database to calculate the incidence rate of GVHD within 1 year of LT using survival analysis. The predictors of GVHD were identified using univariate and multivariate Cox regression analyses. RESULTS From 2010 to 2020, of 88,433 LTs, 383 cases of GVHD occurred within 1 year after LT, resulting in an incidence rate of 1.0% (95% CI: 0.8%-1.3%). We observed no statistically significant change in the incidence of GVHD after LT from 2010 to 2020 (beta-coefficient, -0.07%; 95% CI: -0.17% to 0.04%, p = 0.188). Interestingly, alcohol-associated liver disease was associated with a lower risk of GVHD (adjusted HR, 0.57; 95% CI: 0.36-0.91, p = 0.018), whereas a higher risk was found to be related to a secondary diagnosis of COVID-19 on index admission. CONCLUSION Our study found that the incidence rate of GVHD within 1 year of LT in the United States was 1.0% and remained stable from 2010 to 2020. The predictors associated with GVHD include alcohol-associated liver disease and COVID-19. Our study provides valuable insights into the incidence, risk factors, and outcomes of GVHD after LT.
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Affiliation(s)
- Yuting Huang
- Department of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | | | - Liu Yang
- Division of Hepatology and Liver Transplantation, Mayo Clinic, Jacksonville, Florida, USA
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2
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Kaur M, Singh N, Mital R, Schenk A, Fisher K, Korman AM, Kaffenberger BH, Chung CG. Dermatologic manifestations of acute graft versus host disease after liver transplantation: A case series of 8 patients. JAAD Case Rep 2023; 39:6-13. [PMID: 37554362 PMCID: PMC10404598 DOI: 10.1016/j.jdcr.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Affiliation(s)
- Manjit Kaur
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Navdeep Singh
- Division of Transplant Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Austin Schenk
- Division of Transplant Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristopher Fisher
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Abraham M. Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Catherine G. Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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3
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Cooper JP, Abkowitz JL. How I diagnose and treat acute graft-versus-host disease after solid organ transplantation. Blood 2023; 141:1136-1146. [PMID: 36395067 DOI: 10.1182/blood.2022015954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT) that carries high mortality. Caused by immunocompetent donor leukocytes within the transplanted organ, which become activated against recipient tissues, GVHD typically develops 2 to 12 weeks after SOT and can affect the skin, gastrointestinal tract, liver, and bone marrow. Signs and symptoms are nonspecific and include a rash, nausea, appetite loss, diarrhea, and cytopenias. Pancytopenia from marrow-directed GVHD is the primary driver of mortality. The diagnosis of GVHD is often delayed but should be confirmed by biopsy of an affected organ. Evidence of donor chimerism in blood or marrow supports the diagnosis. When GVHD is diagnosed we initiate treatment with systemic corticosteroids. At that time, if GVHD only involves skin or oral mucosa we also decrease maintenance immunosuppression levels to allow the recipient to reject the donor immune cells. For GVHD involving the marrow we initiate an allogeneic hematopoietic cell donor search early. In this article, we describe 3 cases of GVHD after SOT, outline our approach to diagnosis and management, and then provide analysis of the 3 instructive cases.
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Affiliation(s)
- Jason P Cooper
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Janis L Abkowitz
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
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4
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HTLV-1 infection of donor-derived T cells might promote acute graft-versus-host disease following liver transplantation. Nat Commun 2022; 13:7368. [PMID: 36450748 PMCID: PMC9712688 DOI: 10.1038/s41467-022-35111-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Acute graft versus host disease (aGVHD) is a rare, but severe complication of liver transplantation (LT). It is caused by the activation of donor immune cells in the graft against the host shortly after transplantation, but the contributing pathogenic factors remain unclear. Here we show that human T cell lymphotropic virus type I (HTLV-1) infection of donor T cells is highly associated with aGVHD following LT. The presence of HTLV-1 in peripheral blood and tissue samples from a discovery cohort of 7 aGVHD patients and 17 control patients is assessed with hybridization probes (TargetSeq), mass cytometry (CyTOF), and multiplex immunohistology (IMC). All 7 of our aGVHD patients display detectable HTLV-1 Tax signals by IMC. We identify donor-derived cells based on a Y chromosome-specific genetic marker, EIF1AY. Thus, we confirm the presence of CD4+Tax+EIF1AY+ T cells and Tax+CD68+EIF1AY+ antigen-presenting cells, indicating HTLV-1 infection of donor immune cells. In an independent cohort of 400 patients, we verify that HTLV-1 prevalence correlates with aGVHD incidence, while none of the control viruses shows significant associations. Our findings thus provide new insights into the aetio-pathology of liver-transplantation-associated aGVHD and raise the possibility of preventing aGVHD prior to transplantation.
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5
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Tian M, Lyu Y, Wang B, Liu C, Yu L, Shi JH, Liu XM, Zhang XG, Guo K, Li Y, Hu LS. Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases. World J Clin Cases 2021; 9:9255-9268. [PMID: 34786412 PMCID: PMC8567504 DOI: 10.12998/wjcc.v9.i30.9255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) following liver transplantation (LT) is an unpredictable complication with poor outcome. However, consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking. The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD (aGVHD) following LT and reviewed the pertinent literature.
CASE SUMMARY Between January 1st, 2000 and December 31st, 2020, a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University. Six recipients developed aGVHD with clinical symptoms of fever, rash, diarrhea, and pancytopenia. The incidence of aGVHD was 0.57%. The median time from LT to the clinical presentation of aGVHD was 22.17 d. The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d. All six cases underwent treatment of immunosuppressant adjustment, corticosteroids, human normal immunoglobulin, and antithymocyte globulin/IL-2 antagonists. Despite intensive treatment strategies, 4 patients were deceased due to sepsis, multiple organ failure, and cerebral hemorrhage. The remaining two cases were discharged as treatment successfully. However, one died because of tuberculosis infection on the 6th month of follow-up, the other one was alive healthy during 30 mo of follow-up.
CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom, histopathological features, and the donor T-lymphocyte chimerism. Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD. Moreover, gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.
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Affiliation(s)
- Min Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Bo Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Liang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Jian-Hua Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xiao-Gang Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Kun Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Liang-Shuo Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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6
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Wang L, Yang B, Wei L, Chen D, Zhao Y, Chen Z. Acute graft-versus-host disease after liver transplantation in a close contact with COVID-19: A case report. Transpl Immunol 2021; 68:101435. [PMID: 34216759 PMCID: PMC8245304 DOI: 10.1016/j.trim.2021.101435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Acute graft-versus-host disease (aGVHD) is a rare complication after liver transplantation that characterized by high mortality. We presented a case of aGVHD after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). The patient suffered from fever, oral ulcer, rashes and diarrhea and had a co-infection with Cytomegalovirus (CMV). Short tandem repeat (STR) analysis for cluster of differentiation (CD3) cells and skin biopsy indicated aGVHD. His regimens included high dose of steroids, ruxolitinib, basiliximab, local liver radiotherapy and antibiotics prophylaxis, with the withdrawal of tacrolimus and MMF. Unfortunately, he developed an acute rejection followed by cytomegalovirus infection and lung infection. Soon afterwards he was sent to “isolation ward” due to high suspicion for clinical coronavirus disease 2019 (COVID-19). Fortunately, He was excluded from COVID-19 after nucleic acid and antibody tests. Though closely contact with other COVID-19 patients for a month, the patient was not affected with COVID-19 through his careful protective measures. Finally, the patient recovered after antiviral and antifungal treatment. To our knowledge, this is the first case report of a patient recovered from aGVHD as a close contact.
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Affiliation(s)
- Lu Wang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
| | - Lai Wei
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
| | - Dong Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Yuanyuan Zhao
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Zhishui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
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7
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Zuber J, Boyer O, Neven B, Jollet I, Renac V, Berthaud R, Levy R, Lamarthée B, Visentin J, Marchal A, Gouge-Biebuyck N, Godron-Dubrasquet A, Aladjidi N, Rabah MO, Winter S, Léon J, Dussiot M, Rabant M, Krid S, Krug P, Charbit M, Lacaille F, André I, Cavazzana M, Llanas B, Allard L, Pirenne F, Gross S, Djoudi R, Tiberghien P, Taupin JL, Blanche S, Salomon R. Donor-targeted serotherapy as a rescue therapy for steroid-resistant acute GVHD after HLA-mismatched kidney transplantation. Am J Transplant 2020; 20:2243-2253. [PMID: 32065452 DOI: 10.1111/ajt.15827] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023]
Abstract
Acute graft-versus-host disease (GVHD) is a rare but frequently lethal complication after solid organ transplantation. GVHD occurs in unduly immunocompromised hosts but requires the escalation of immunosuppression, which does not discriminate between host and donor cells. In contrast, donor-targeted therapy would ideally mitigate graft-versus-host reactivity while sparing recipient immune functions. We report two children with end-stage renal disease and severe primary immune deficiency (Schimke syndrome) who developed severe steroid-resistant acute GVHD along with full and sustained donor T cell chimerism after isolated kidney transplantation. Facing a therapeutic dead end, we used a novel strategy based on the adoptive transfer of anti-HLA donor-specific antibodies (DSAs) through the transfusion of highly selected plasma. After approval by the appropriate regulatory authority, an urgent nationwide search was launched among more than 3800 registered blood donors with known anti-HLA sensitization. Adoptively transferred DSAs bound to and selectively depleted circulating donor T cells. The administration of DSA-rich plasma was well tolerated and notably did not induce antibody-mediated rejection of the renal allografts. Acute GVHD symptoms promptly resolved in one child. This report provides a proof of concept for a highly targeted novel therapeutic approach for solid organ transplantation-associated GVHD.
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Affiliation(s)
- Julien Zuber
- Paris University, Paris, France.,Laboratory of Human Lymphohematopoiesis, Inserm UMR 1163, Imagine Institute, Paris, France.,Department of Adult Kidney Transplantation, Necker Hospital, Paris, France
| | - Olivia Boyer
- Paris University, Paris, France.,Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Bénédicte Neven
- Paris University, Paris, France.,Department of Pediatric Immuno-hematology, Necker Hospital, Paris, France
| | - Isabelle Jollet
- Etablissement Français du Sang Nouvelle Aquitaine, HLA Laboratory, Poitiers, France
| | - Virginie Renac
- Etablissement Français du Sang Bretagne, HLA Laboratory, Rennes, France
| | - Romain Berthaud
- Paris University, Paris, France.,Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Romain Levy
- Paris University, Paris, France.,Department of Pediatric Immuno-hematology, Necker Hospital, Paris, France
| | - Baptiste Lamarthée
- Laboratory of Human Lymphohematopoiesis, Inserm UMR 1163, Imagine Institute, Paris, France
| | - Jonathan Visentin
- CHU de Bordeaux, Laboratoire d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Armance Marchal
- Laboratory of Human Lymphohematopoiesis, Inserm UMR 1163, Imagine Institute, Paris, France
| | - Nathalie Gouge-Biebuyck
- Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Astrid Godron-Dubrasquet
- Department of Pediatric Nephrology and Kidney Transplantation, Pellegrin Hospital, Bordeaux, France
| | - Nathalie Aladjidi
- Department of Pediatric Onco-Hematology, Pellegrin Hospital, Bordeaux, France
| | - Melissa O Rabah
- Paris University, Paris, France.,Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Sarah Winter
- Paris University, Paris, France.,Department of Pediatric Immuno-hematology, Necker Hospital, Paris, France
| | - Juliette Léon
- Department of Pathology, Necker Hospital, Paris, France
| | - Michael Dussiot
- Laboratory of Molecular Mechanisms of Hematologic Disorders and Therapeutic Implications, Inserm UMRS 1163, Imagine Institute, Paris, France
| | - Marion Rabant
- Paris University, Paris, France.,Department of Pathology, Necker Hospital, Paris, France
| | - Saoussen Krid
- Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Pauline Krug
- Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Marina Charbit
- Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker Hospital, Paris, France
| | - Isabelle André
- Laboratory of Human Lymphohematopoiesis, Inserm UMR 1163, Imagine Institute, Paris, France
| | - Marina Cavazzana
- Paris University, Paris, France.,Laboratory of Human Lymphohematopoiesis, Inserm UMR 1163, Imagine Institute, Paris, France.,Biotherapy Clinical Investigation Center, Necker Hospital, Paris, France
| | - Brigitte Llanas
- Department of Pediatric Nephrology and Kidney Transplantation, Pellegrin Hospital, Bordeaux, France
| | - Lise Allard
- Department of Pediatric Nephrology and Kidney Transplantation, Pellegrin Hospital, Bordeaux, France
| | - France Pirenne
- Etablissement Français du Sang, Ile-de-France, Créteil, France.,Etablissement Français du Sang, St. Denis, France
| | - Sylvie Gross
- Etablissement Français du Sang, St. Denis, France
| | | | - Pierre Tiberghien
- Etablissement Français du Sang, St. Denis, France.,Etablissement Français du Sang, UMR 1098, Inserm, Université de Franche-Comté, Besançon, France
| | - Jean-Luc Taupin
- Laboratory of Immunology and Histocompatibility, Saint Louis Hospital, Paris, France
| | - Stéphane Blanche
- Paris University, Paris, France.,Department of Pediatric Immuno-hematology, Necker Hospital, Paris, France
| | - Rémi Salomon
- Paris University, Paris, France.,Department of Pediatric Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
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8
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Mia MB, Saxena RK. Poly dispersed acid-functionalized single walled carbon nanotubes target activated T and B cells to suppress acute and chronic GVHD in mouse model. Immunol Lett 2020; 224:30-37. [PMID: 32504776 DOI: 10.1016/j.imlet.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 12/27/2022]
Abstract
Graft versus host disease (GVHD) results from hyper-activation of transplanted lymphocytes against the host antigens. Bone marrow transplantation in humans as well as some cases of blood transfusion and organ transplantation are associated with a strong GVH reaction resulting in GVHD that in many cases may be fatal. We had previously shown that poly-dispersed acid-functionalized single-walled carbon nanotubes (AF-SWCNTs) specifically target activated T and B lymphocytes and kill them. In the present study, efficacy of AF-SWCNTs to suppress the GVH reaction was tested in the mouse model. Acute GVHD was induced in mice by administering intravenously 30 or 60 million spleen cells from a parental strain (C57bl/6 mouse, MHC haplotype H-2b) to host (C57bl/6 x Balb/c) F1 mice (MHC haplotype H-2b/d)and waiting for 8-10 days. Chronic GVHD was similarly induced by administration of 30 million parent spleen cells to F1 mice and waiting for a period of 60 days. Our results demonstrate a marked decline in splenomegaly and recovery of spleen T (both CD4 and CD8) and B cells in GVHD mice treated with AF-SWCNTs. AF-SWCNTs treatment also limited T and B cell proliferation by restricting S-phage of cell cycle. Generation of anti-host cytotoxic T cells (CTLs) was also markedly suppressed by AF-SWCNT treatment of acute GVHD mice, and a significant reduction in the generation of anti-host antibodies could also be demonstrated. Taken together, our results suggest that the AF-SWCNTs can be considered as a potential therapeutic agent for treating GVHD.
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Affiliation(s)
- Md Babu Mia
- Faculty of Life Sciences and Biotechnology, South Asian University, Akbar Bhawan, Chanakyapuri, New Delhi, 110021, India
| | - Rajiv K Saxena
- Faculty of Life Sciences and Biotechnology, South Asian University, Akbar Bhawan, Chanakyapuri, New Delhi, 110021, India.
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9
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Wood A, Eghtesad B, Lindenmeyer CC. Graft-Versus-Host Disease After Liver Transplantation. Clin Liver Dis (Hoboken) 2020; 15:81-84. [PMID: 32226622 PMCID: PMC7098667 DOI: 10.1002/cld.884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023] Open
Abstract
http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-reading-wood a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-interview-lindenmeyer an interview with the author.
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Affiliation(s)
- Ashley Wood
- Department of Internal MedicineCleveland ClinicClevelandOH
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
| | - Christina C. Lindenmeyer
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
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10
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Gonultas F, Akbulut S, Barut B, Kutluturk K, Yilmaz S. Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers. Eur J Gastroenterol Hepatol 2020; 32:95-100. [PMID: 31524772 DOI: 10.1097/meg.0000000000001530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT). METHODS Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated. RESULTS There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications. CONCLUSION GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.
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Affiliation(s)
- Fatih Gonultas
- Liver Transplant Institute, Inonu University, Malatya, Turkey
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11
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Chen W, Ma T, Bai X, Zhang X, Li G, Lao M, Liang T. Acute Graft-vs-Host Disease After Liver Transplantation in a Patient Presenting With Neurogenic Symptoms as the Single Primary Manifestation: A Case Report. Transplant Proc 2018; 50:4028-4032. [DOI: 10.1016/j.transproceed.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/23/2018] [Indexed: 12/24/2022]
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12
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Minnee RC, Fieuws S, Jochmans I, Aerts R, Sainz Barriga M, Debaveye Y, Maertens J, Vandenberghe P, Laleman W, van der Merwe S, Verslype C, Cassiman D, Ferdinande P, Nevens F, Pirenne J, Monbaliu D. Improved survival after LTx-associated acute GVHD with mAb therapy targeting IL2RAb and soluble TNFAb: Single-center experience and systematic review. Am J Transplant 2018; 18:3007-3020. [PMID: 29734503 DOI: 10.1111/ajt.14923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 01/25/2023]
Abstract
Acute graft-versus-host disease (GVHD) after liver transplant (LTx) is a rare complication with a high mortality rate. Recently, monoclonal antibody (mAb) treatment, specifically with anti-interleukin 2 receptor antibodies (IL2RAb) and anti-tumor necrosis factor-α antibodies (TNFAb), has gained increasing interest. However, evidence is mostly limited to case reports and the efficacy remains unclear. Here, we describe 5 patients with LTx-associated GVHD from our center and provide the results of our systematic literature review to evaluate the potential therapeutic benefit of IL2RAb/TNFAb treatment. Of the combined population of 155 patients (5 in our center and 150 through systematic search), 24 were given mAb (15.5%)-4 with TNFAb (2.6%) and 17 with IL2RAb (11%) ("mAb group")-and compared with patients who received other treatments (referred to as "no-mAb group"). Two-sided Fisher exact tests revealed a better survival when comparing treatment with mAb versus no-mAb (11/24 vs 27/131; P = .018), TNFAb versus no-mAb (3/4 vs 27/131; P = .034), and IL2RAb versus no-mAb (8/17 vs 27/131; P = .029). This systematic review suggests a beneficial effect of mAb treatment and a promising role for TNFAb and IL2RAb as a first-line strategy to treat LTx-associated acute GVHD.
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Affiliation(s)
- R C Minnee
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - S Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven-University of Leuven, Leuven, Belgium.,University Hasselt, Hasselt, Belgium
| | - I Jochmans
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - R Aerts
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - M Sainz Barriga
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Y Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - J Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - P Vandenberghe
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - W Laleman
- Department of Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - S van der Merwe
- Department of Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - C Verslype
- Department of Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - D Cassiman
- Department of Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - P Ferdinande
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - F Nevens
- Department of Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - J Pirenne
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - D Monbaliu
- Abdominal transplant surgery and transplantation coordination, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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13
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Graft Versus Host Disease After Liver Transplantation in Adults: A Case series, Review of Literature, and an Approach to Management. Transplantation 2017; 100:2661-2670. [PMID: 27495762 DOI: 10.1097/tp.0000000000001406] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Graft-versus-host-disease (GVHD) after liver transplantation (LT) is a deadly complication with very limited data on risk factors, diagnosis and management. We report a case series and a comprehensive review of the literature. METHODS Data were systematically extracted from reports of GVHD after LT, and from the United Network for Organ Sharing database. Group comparisons were performed. RESULTS One hundred fifty-six adult patients with GVHD after LT have been reported. Median time to GVHD onset was 28 days. Clinical features were skin rash (92%), pancytopenia (78%), and diarrhea (65%). Six-month mortality with GVHD after LT was 73%. Sepsis was the most common cause of death (60%). Enterobacter bacteremia, invasive aspergillosis, and disseminated Candida infections were frequently reported. Recipient age over 50 years is a risk factor for GVHD after LT. Hepatocellular carcinoma was overrepresented, whereas chronic hepatitis C was underrepresented, in reported United States GVHD cases relative to all United Network for Organ Sharing database LT cases. Mortality rate with treatment of GVHD after LT was 84% with high-dose steroids alone, 75% to 100% with regimens using dose increases of calcineurin inhibitors, and 55% with IL-2 antagonists. Mortality was 25% in small case series using the CD2-blocker alefacept or TNF-α antagonists. CONCLUSIONS Age older than 50 years and hepatocellular carcinoma appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and calcineurin inhibitors are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diagnostic algorithm to assist clinicians in managing adults with GVHD after LT.
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14
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Acute Graft-vs-Host Disease After Liver Transplantation: Experience at a High-volume Liver Transplantation Center in Korea. Transplant Proc 2016; 48:3368-3372. [DOI: 10.1016/j.transproceed.2016.08.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/22/2016] [Indexed: 01/20/2023]
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15
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A rare but life-threatening complication in liver transplant recipients. GASTROENTEROLOGY REVIEW 2016; 11:62-4. [PMID: 27110316 PMCID: PMC4814535 DOI: 10.5114/pg.2015.52562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/11/2015] [Indexed: 11/17/2022]
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16
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Qiu W, Lv GY, Jiang C, Zhang P, Sun XD, Shi XJ, Liu XY, Wang GY. Successful salvage treatment of acute graft-versus-host disease after liver transplantation by withdrawal of immunosuppression: a case report. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:38-43. [PMID: 26925149 PMCID: PMC4767263 DOI: 10.14701/kjhbps.2016.20.1.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
Acute graft-versus-host disease (GVHD) following liver transplantation is a rare but fatal complication. The correct diagnosis and management of GVHD after liver transplantation are still major challenges. Herein, we reported successful salvage treatment of acute GVHD by withdrawal of immunosuppression in a patient who presented with fever, skin rashes, and decreased blood cell counts after liver transplantation. This case highlights the need for awareness of drug-induced liver injury if liver function tests are elevated during treatment, especially in patients taking multiple potentially hepatotoxic drugs, such as broad-spectrum antibiotics. When occurs, an artificial liver support system is a useful tool to provide temporary support of liver function for the patient in the event of drug-induced liver injury.
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Affiliation(s)
- Wei Qiu
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Guo-Yue Lv
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Chao Jiang
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Ping Zhang
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Xiao-Dong Sun
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Xiao-Ju Shi
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
| | - Xue-Yan Liu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guang-Yi Wang
- Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China
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17
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Lee HJ, Lee SM, Kim BC, Chu CW, Yang KH, Ryu JH, Moon KM, Choi KU, Kim HH. A Case of Acute Graft versus Host Disease after Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hyun Ji Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byung Chang Kim
- Department of Laboratory Medicine, Maryknoll Medical Center, Busan, Korea
| | - Chong Woo Chu
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Kwang Ho Yang
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Ki Myung Moon
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Kyung-Un Choi
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Hyung Hoi Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
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18
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Rogulj IM, Deeg J, Lee SJ. Acute graft versus host disease after orthotopic liver transplantation. J Hematol Oncol 2012; 5:50. [PMID: 22889203 PMCID: PMC3445845 DOI: 10.1186/1756-8722-5-50] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/27/2012] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Inga Mandac Rogulj
- University of Zagreb School of Medicine, University Hospital Merkur, Zagreb, Croatia
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