A Case of Acute Graft versus Host Disease after Liver Transplantation

Hyun Ji Lee; Sun Min Lee; Byung Chang Kim; Chong Woo Chu; Kwang Ho Yang; Je Ho Ryu; Ki Myung Moon; Kyung-Un Choi; Hyung Hoi Kim

doi:10.4285/jkstn.2013.27.1.15

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Lee, Lee, Kim, Chu, Yang, Ryu, Moon, Choi, and Kim: A Case of Acute Graft versus Host Disease after Liver Transplantation

Case Report

J Korean Soc Transplant 2013;27(1):15-20.

Published online: 11 March 2013

DOI: https://doi.org/10.4285/jkstn.2013.27.1.15

A Case of Acute Graft versus Host Disease after Liver Transplantation

Hyun Ji Lee, M.D.¹, Sun Min Lee, M.D.¹, Byung Chang Kim, M.D.², Chong Woo Chu, M.D.³, Kwang Ho Yang, M.D.³, Je Ho Ryu, M.D.³, Ki Myung Moon, M.D.³, Kyung-Un Choi, M.D.⁴, Hyung Hoi Kim, M.D.¹

¹Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea

²Department of Laboratory Medicine, Maryknoll Medical Center, Pusan National University School of Medicine, Busan, Korea

³Department of Surgery, Pusan National University School of Medicine, Busan, Korea

⁴Department of and Pathology, Pusan National University School of Medicine, Busan, Korea

책임저자：김형회, 부산시 서구 구덕로 179 부산대학교 의학전문대학원 진단검사의학교실, 602-739 Tel: 051-240-7414, Fax: 051-247-6560 E-mail: hhkim@pusan.ac.kr 602-739 Tel: 051-240-7414, Fax: 051-247-6560 E-mail: hhkim@pusan.ac.kr

본 연구는 2012 대한수혈학회 포스터 발표되었음.

Received 27 July 201228 October 2012 Accepted 21 November 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The mortality rate of patients with acute graft versus host disease (GVHD) after liver transplantation is very high. Autoimmune hepatitis and diabetes mellitus (DM) is the risk factors of GVHD. Human leukocyte antigen (HLA)-homozygote donor with one way donor-recipient HLA matching is on the risk of fatal GVHD following living donor liver transplantation (LDLT). If recipient has more than one risk factors of GVHD and is going to LDLT, HLA typing is needed to identify donor-dominant one-way HLA matching and helpful to diagnose and treat early and survival of patient will be improved. We report a case of GVHD after liver transplantation for hepatocellular carcinoma and DM who received an allograft from his HLA-homozygous son.

Keywords: Acute, Graft versus host disease, Liver transplantation, HLA antigens

REFERENCES

1). Zhang Y, Ruiz P. Solid organ transplant-associated acute graft-versus-host disease. Arch Pathol Lab Med. 2010; 134:1220–4.

2). Kohler S, Pascher A, Junge G, Sauer IM, Nagy M, Schönemann C, et al. Graft versus host disease after liver transplantation: a single center experience and review of literature. Transpl Int. 2008; 21:441–51.

3). Chan EY, Larson AM, Gernsheimer TB, Kowdley KV, Carithers RL Jr, Reyes JD, et al. Recipient and donor factors influence the incidence of graft-vs.-host disease in liver transplant patients. Liver Transpl. 2007; 13:516–22.

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; 18:84–9.

5). Guo ZY, He XS, Wu LW, Zhu XF, Ju WQ, Wang DP, et al. Graft-verse-host disease after liver transplantation: a report of two cases and review of literature. World J Gastroenterol. 2008; 14:974–9.

6). Taylor AL, Gibbs P, Bradley JA. Acute graft versus host disease following liver transplantation: the enemy within. Am J Transplant. 2004; 4:466–74.

7). 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; 5:2968–73.

8). Goker H, Haznedaroglu IC, Chao NJ. Acute graft-vs-host disease: pathobiology and management. Exp Hematol. 2001; 29:259–77.

9). Soejima Y, Shimada M, Suehiro T, Hiroshige S, Gondo H, Takami A, et al. Graft-versus-host disease following living donor liver transplantation. Liver Transpl. 2004; 10:460–4.

10). 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; 12:140–5.

11). Cho EH, Suh KS, Yang SH, Lee HW, Cho JY, Cho YB, et al. Acute graft versus host disease following living donor liver transplantation: first Korean report. Hepatogastroenterology. 2007; 54:2120–2.

12). Kim HY, Yi NJ, Suh KS, Hong G, Jeon YM, Lee KW, et al. Graft-versus-host disease after liver transplantation. Korean J Hepatobiliary Pancreat Surg. 2010; 14:235–40.

Fig. 1.

Erythematous to violaceous scaly papules and patches on the whole body and acral erythema.

Fig. 2.

After onset of acute graft versus host diease (GVHD), white blood cell (WBC), and platelet count (PLT) were gradually deceased. Patient died at postoperative day (POD) 52. Abbreviation: OP, operative day.

Fig. 3.

Direct sequencing of exon 2,3 showing heterozygous pattern of recipient and homozygous pattern. Abbreviation: HLA, human leukocyte antigen.

Table 1.

Laboratory results at pretransplantation

	Result
	Recipient	Donor
WBC (/μ L)	3,360	4,570
Hemoglobin	12.2	16.7
PLT (K/μ L)	112	271
Prothrombin time	12.1	10.9
aPTT	35.7	31.6
AST	46	17
ALT	34	13
ICG (R15)	37.6	5.4
T. bilirubin	1.5	0.9
Anti-HAV Ab IgM	Negative	Negative
HBsAg	Highly reactive	Negative
Anti-HCV Ab	Negative	Negative
CMV IgG	Positive	Negative
CMV IgM	Negative	Negative
Anti-HIV Ab	Negative	Negative
Blood type	A(＋)	A(＋)

Abbreviations: WBC, white blood cell; PLT, platelet; aPTT, acti-vated partial thromboplastin time; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ICG, indocyanine green; Anti-HAV Ab IgM, antihepatitis A virus antibody IgM; HBsAg, hepatitis B virus surface antigen; Anti-HCV Ab, antihepatitis C virus antibody; CMV IgG, cytomegalovirus immunoglobulin G; CMV IgM, cytomegalovirus immunoglobulin M; Anti-HIV Ab, antihepatitis immunodeficiency virus antibody.

Table 2.

Summary of patients suffering for graft versus host disease after liver transplantation and their outcomes from literature

Case No.	Age (yr)	Sex	Etiology	HLA recipient	HLA donor	Outcome POD	Onset POD	Reference
1	51	M	HBV-LC, HCC	A 2, -	A 2, -	138	56	11
				B 46, 51	B46, -
				DR 8, 4	DR 8, -
2	37	NA	PBC	A 24, 34	A 24, -	36	24	10
				B 52, 62	B 52, -
				DR 15, 9	DR 15, -
3	59	NA	HCC	A 24, 31	A 24, -	149	38	10
				B 52, 35	B 52, -
				DR 15, 8	DR 15, -
4	48	NA	HCC, alcohol	A 33, 24	A 33, -	61	35	10
				B 44, 62	B 44, -
				DR 6, 4	DR 6, -
5	62	NA	HCC, HCV	A 24, 31	A 24, -	139	42	10
				B 52, 51	B 52, -
				DR 15, 14	DR 15, -
6	50	NA	PBC	A 33, 3	A 33, -	540	114	10
				B 44, 40	B 44, -
				DR 13, 9	DR 13, -
7	8 mo	NA	Biliary atresia	A 24, 2	A 24, -	43	14	10
				B 52, 61	B 52, -
				DR 15, 8	DR 15, -
8	6 mo	NA	Biliary atresia	A 2, 23	A 2, -	217	23	10
				B 44, 54	B 44, -
				DR 13, 4	DR 13, -
9	38	NA	Alcohol induced liver cirrhosis	A 33, 3	A 33, -	36	24	10
				B 4403, 4402	B 4403, -
				DR 13, 4	DR 13, -
10	9 mo	F	Biliary atresia	DR 3, 7	A 1, -	Alive	60	9
					B 8, -	(250)
					DR 3, -
11	8 mo	F	Biliary atresia	A 2, 24	A 24, -	43	27	9
				B 52, 61	B 52, -
				DR 8, 15	DR 15, -
				DQ 3, 6	DQ 6, -
12	50	F	PBC	A 26, 33	A 33, -	Alive	114	9
				B 44, 40	B 44, -
				C 14, 8	C 14, -
				DR 13, 9	DR 13, -
13	48	M	Alcohol induced liver cirrhosis, HCC	A 33, 24	A 33, -	61	42	9
				B 44, 62	B 44, -
				DR 6, 4	DR 6, -
				DQ 6, 3	DQ 6, -

Abbreviations: HLA, human leukocyte antigen; POD, postoperative day; M, male; NA, not available; HBV-LC, hepatitis B virus-related liver cirrhosis; HCC, hepatocellular carcinoma; PBC, primary biliary cirrhosis; F, female.

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