scholarly journals Solid-Organ Graft-Versus-Host Disease After Liver Transplant: A Case Report

2016 ◽  
Vol 36 (3) ◽  
pp. e7-e11 ◽  
Author(s):  
Jonathan S. Auerbach ◽  
Christopher K. Schott
Keyword(s):  
Liver Transplant ◽  
Graft Versus Host Disease ◽  
Rare Complication ◽  
Organ Transplant ◽  
Signs And Symptoms ◽  
High Dose ◽  
Solid Organ ◽  
Host Disease ◽  
Graft Versus Host ◽  
Evidence Based Guidelines

Solid-organ transplant graft-versus-host disease (SOT-GVHD) is a rare complication of organ transplant that is associated with high mortality. The initial signs and symptoms are vague, so this disease is easily confused with other posttransplant complications. A case of SOT-GVHD occurred after orthotopic liver transplant for liver failure due to hepatitis C in a patient in a Veterans Affairs intensive care unit. The patient had dehydration, acute kidney injuries, rashes, diarrhea, and pancytopenia. Results of skin biopsy, bone marrow biopsy, and cytogenetic studies were consistent with SOT-GVHD. Despite supportive care including antibiotics, antiviral and antifungal therapy, high-dose steroids, antithymoglobulin and neupogen, the patient died of overwhelming sepsis. Owing to the rarity of SOT-GVHD, no evidence-based guidelines or recommendations for treatment exist. Treatment includes high-dose corticosteroids and antibiotic, antifungal, and antiviral prophylaxis. Treatment of liver transplant–related GVHD with anti–tumor necrosis factor a agents has been successful.

scholarly journals Graft Versus Host Disease

1970 ◽  
Vol 11 (2) ◽  
Author(s):  
Janeve Desy MD ◽  
Marc Deschenes MD
Keyword(s):  
Liver Transplantation ◽  
Graft Versus Host Disease ◽  
Rare Complication ◽  
Organ Transplant ◽  
Maculopapular Rash ◽  
Solid Organ Transplant ◽  
Hla Typing ◽  
Solid Organ ◽  
Host Disease ◽  
Graft Versus Host

Graft Versus Host Disease (GVHD) is a rare complication of liver transplantation with a mortality rate exceeding 65%. A 53-year-old male presented with a diffuse maculopapular rash, diarrhea, lymphopenia, fever, and confusion 14 days after orthotopic liver transplantation for hepatitis B cirrhosis. Skin biopsy and HLA- typing of peripheral blood confirmed a diagnosis of solid organ transplant related GVHD. This report summarizes what is known about this disease and emphasizes the importance of early diagnosis, which is one of the only factors known to improve the mortality of this deadly condition.

Two Cases and a Review of Graft-Versus-Host Disease and the Role of Hepatitis C Treatment in Liver Transplant Patients

2018 ◽  
Vol 28 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Sonali D. Advani ◽  
Anoma Nellore ◽  
Giorgos Hadjivassiliou ◽  
Devin E. Eckhoff ◽  
Donna Salzman ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
Graft Versus Host Disease ◽  
High Dose ◽  
Solid Organ ◽  
Hcv Treatment ◽  
Host Disease ◽  
Graft Versus Host ◽  
Transplant Patients

Graft-versus-host disease (GvHD) is a rare but fatal complication after solid organ transplantation arising in 1% to 2% of cases. We report 2 cases of GvHD after orthotopic liver transplantation. Both patients had a history of hepatitis C virus (HCV) infection prior to transplantation. Both cases presented between 1 and 4 months after transplantation with rash, pancytopenia, and/or diarrhea. Our second case also developed oral and ocular manifestations after liver transplantation, which are more commonly described after stem cell transplantation. Diagnosis in both cases was made by clinical presentation in conjunction with histopathology and flow cytometry. Both patients were treated by increasing immunosuppression with tacrolimus and high-dose steroids. Response to treatment differed based on the degree of pancytopenia. Our case report is distinguished by several factors such as the context of GvHD presentation and the role of HCV treatment. Diagnosis of GvHD is difficult and often delayed due to nonspecific presentation that overlaps with other conditions. Furthermore, the relation between HCV treatment and potential initiation of GvHD in solid organ transplant patients is unclear.

scholarly journals Skin-Limited Graft-versus-Host Disease after Pancreatic Transplantation

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Muneeb Ilyas ◽  
Elika Hoss ◽  
David J. DiCaudo ◽  
Hasan Khamash ◽  
Mark R. Pittelkow ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Organ Transplant ◽  
Organ Transplant Recipient ◽  
Solid Organ Transplant Recipient ◽  
Solid Organ ◽  
Pancreatic Transplantation ◽  
Case Presentation ◽  
Host Disease ◽  
Graft Versus Host

Introduction. The phenomenon of graft-versus-host disease, a solid organ transplant recipient, is a rare development with a very poor prognosis. Case Presentation. A 40-year-old woman with type 1 diabetes developed cutaneous graft-versus-host disease following second pancreas transplantation. Conclusion. The development of a nonspecific rash in the early posttransplant period following a pancreas transplant warrants suspicion for graft-versus-host disease.

Solid Organ Transplant-Associated Acute Graft-Versus-Host Disease

2010 ◽  
Vol 134 (8) ◽  
pp. 1220-1224 ◽  
Author(s):  
Yaxia Zhang ◽  
Phillip Ruiz
Keyword(s):  
Bone Marrow ◽  
Graft Versus Host Disease ◽  
Clinical Symptoms ◽  
Bone Marrow Failure ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Multisystem Disease ◽  
Host Disease ◽  
Graft Versus Host

Abstract Solid organ transplant–associated graft-versus-host disease is an infrequent and potentially lethal complication. The incidence of this complication varies according to the type of organ transplant with higher rates associated with liver and small bowel transplants. The clinical presentation typically includes fever and skin rash, and most cases quickly advance to become a multisystem disease affecting the bone marrow and other nontransplanted solid organs. The diagnosis is based on the clinical symptoms, pathologic changes in biopsied tissues, and systemic lymphoid chimerism. The mortality of this disease can exceed 75% after liver transplant and most patients die from infections or hemorrhage due to bone marrow failure. There is no standard treatment strategy for this complication, and the management mainly consists of both prophylaxis and immediate treatment without delay. This short review summarizes the current pathogenesis, diagnosis, and treatment of this entity.

scholarly journals Graft-versus-Host Disease after Living-Unrelated Kidney Transplantation

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
N. Zacharias ◽  
M. H. Gallichio ◽  
D. J. Conti
Keyword(s):  
Kidney Transplantation ◽  
Graft Versus Host Disease ◽  
Rare Complication ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Intravenous Hyperalimentation ◽  
Host Disease ◽  
Graft Versus Host ◽  
Work Up ◽  
Host Tissues

Graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation and consists of a reaction of donor derived immune cells directed against host tissues. The vast majority of cases reported in the literature involve liver, small intestine and pancreas transplantation. We report a case of GVHD in a 48-year-old man after living-unrelated kidney transplantation at another center. Six months postoperatively he developed a skin rash, anorexia, and diarrhea that resulted in malnutrition and a 90 pound weight loss. At this point he was transferred to our center with a BMI of 16 and severe cachexia. Intravenous hyperalimentation was initiated and an extensive work-up for an infectious etiology was performed and was negative. An esophagogastroduodenoscopy was performed and revealed nodularity of the gastric mucosa, atrophy, and edema in the first and second portion of his duodenum. Biopsy findings were consistent with GVHD. Aggressive immunosuppressive therapy was instituted with a good response. The anorexia and diarrhea resolved, and he was discharged on hospital day 20. Three months later, there had been no recurrence of the diarrhea, the patient had gained an additional 40 pounds, BMI of 25, and a repeat upper endoscopy revealed complete resolution of the initial endoscopic abnormalities.

scholarly journals Small bowel necrosis and perforation due to sodium polystyrene sulfonate in the setting of graft versus host disease and fulminant Clostridium difficile infection

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Leah Sukri ◽  
Laura DiChiacchio ◽  
Philip J Wasicek ◽  
Stephen M Kavic
Keyword(s):  
Small Bowel ◽  
Clostridium Difficile ◽  
Graft Versus Host Disease ◽  
Organ Transplant ◽  
Common Adverse Event ◽  
Sodium Polystyrene Sulfonate ◽  
Solid Organ ◽  
Polystyrene Sulfonate ◽  
Host Disease ◽  
Graft Versus Host

Abstract Gastrointestinal injury is a common adverse event associated with use of sodium polystyrene sulfonate (SPS), tradename Kayexalate. Risk factors for SPS-mediated gastrointestinal necrosis include chronic kidney disease, solid organ transplant recipiency and recent surgery. This report presents a patient with past medical history significant for acute myeloid leukemia (AML) complicated by graft versus host disease (GvHD) and Clostridium difficile colitis who initially presented with small bowel obstruction. She was taken to the operating room and her small bowel pathology was significant for transmural necrosis with SPS crystals in the granulation tissue, despite last receiving SPS over a year ago. Previous mucosal damage should be considered as a risk factor for SPS-mediated injury and the effects of this medication may occur longer than previously thought.

Extracorporeal photopheresis in solid organ transplant-associated acute graft-versus-host disease

Transfusion ◽  
2016 ◽  
Vol 56 (4) ◽  
pp. 962-969 ◽  
Author(s):  
Brett L. Houston ◽  
Matthew Yan ◽  
Kathryn Tinckam ◽  
Suzanne Kamel-Reid ◽  
Hong Chang ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Extracorporeal Photopheresis ◽  
Host Disease ◽  
Graft Versus Host ◽  
Acute Graft
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