Details

Autor(en) / Beteiligte

• Mitra, Arnab
• Zaman, Atif
• Jou, Janice
• Lhewa, Dekey
• Ahn, Joseph

Titel

Graft-Versus-Host Disease in a Post-Liver Transplant Patient: 2419

Ist Teil von

• The American journal of gastroenterology, 2018-10, Vol.113 (Supplement), p.S1348-S1348

Ort / Verlag

New York: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2018

Beschreibungen/Notizen

• GVHD (graft-versus-host disease) is a condition in which transplanted lymphocytes from a donor recognize host tissue as 'foreign,' leading to organ damage and oftentimes death. The onset of GVHD after a solid-organ transplant is quite rare, ranging from 1-2% but is associated with significant mortality up to 85%. Our case is a 58 year old with Hepatitis C and alcoholic cirrhosis complicated by hepatocellular carcinoma who underwent orthotopic liver transplant. The donor and recipient had appropriate ABO matching, in addition to donor being CMV (cytomegalovirus) positive and recipient being CMV negative. The patient was started on standard immunosuppression in addition to bacterial and viral infectious prophylaxis after surgery. A few weeks after transplant, the patient was hospitalized with progressive fatigue, diarrhea, and fever to 39.2 Celsius. On initial presentation, leukopenia and reduced absolute neutrophil count of 2420 were seen. Initial infectious work-up was unremarkable including a negative C. diff result. Patient then developed worsening diarrhea among other symptoms, and had a marked decrease in leukocytes resulting in severe neutropenia. Given worsening nausea and diarrhea, upper endoscopy and flexible sigmoidoscopy were performed. Sigmoidoscopy demonstrated diffuse moderate inflammation with congestion/edema, erythema, and granularity in rectum, sigmoid, and descending colon. Similar findings were seen in the stomach and duodenum during upper endoscopy with biopsies consistent with acute GVHD in stomach, duodenum, and colon. Patient was immediately started on high-dose steroids in addition to receiving granulocyte-colony stimulating factor to help with count recovery and had only mild transient improvement. The patient unfortunately had rapid decompensation soon thereafter with respiratory failure, acute kidney injury, and septic shock with Gram-negative rod bacteremia diagnosed and soon passed away. GVHD post-liver transplant is rare but associated with significant mortality, most often related to infection. Literature has demonstrated some identifiable risk factors including age of recipient, HLA match between donor and recipient, hepatocellular carcinoma, and alcoholic liver disease. The onset of fever, diarrhea, pancytopenia and skin rash after solid organ transplant should raise suspicion for GVHD. Understanding the risk factors and clinical course is important for early recognition and to improve outcomes.