Abstract:

Objective

To investigate the diagnosis and treatment experience of acute graftversus-host disease （aGVHD） after liver transplantation.

Methods

Clinical data of 4 patients with aGVHD after liver transplantation admitted to the 900^th Hospital from January 2000 to January 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，3 patients were male and 1 female，aged 67，59，50 and 51 years，respectively. Classical orthotopic liver transplantation was performed in 4 cases. Bile drainage tube and gastroenteric nutritional tube were routinely placed during the surgery. The immunosuppressant regimen was methylprednisolone + tacrolimus + mycophenolate mofetil. The diagnosis and treatment experience of aGVHD after liver transplantation was summarized and analyzed.

Results

The incidence of aGVHD after liver transplantation was 0.6%（4/650）. The onset time of aGVHD was 12.0-21.0 d after surgery，with a median time of 16.5 d. Clinical characteristics of aGVHD after liver transplantation were as follows:（1） The onset time was 2-4 weeks after liver transplantation；（2） Typical clinical manifestations included fever，rash，diarrhea and pancytopenia；（3） Typical pathological manifestations of skin biopsy，epidermal reticular hyperkeratosis+，dyskeratosis of colloid bodies+，vacuolar degeneration of basal layer+++，vacuolar interfacial dermatitis++，and formation of epidermal cracks；dermal pigment incontinence+，superficial perivascular inflammation+. Inflammatory cell composition: lymphocytes+ and monocytes+. Steroid hormone shock therapy was adopted，and then decreased to 20 mg oral maintenance therapy. Attention was paid to adjusting the immunosuppressant dosage. Infection and gastrointestinal bleeding were prevented.4 cases had normal transplanted liver function during the onset，1 case obtained alleviated clinical symptoms and normal myelogram after treatment. The remission rate of aGVHD was 1/4. 4 patients died within 7.0-41.0 d after onset，with a median survival time of 17.8 d. The mortality rate reached 4/4，including 1 case of gastrointestinal bleeding，1 case of cerebral hemorrhage and 2 cases of multiple organ failure.

Conclusions

The incidence rate of aGVHD is low，whereas the mortality rate is extremely high after liver transplantation. The diagnosis relies on typical clinical manifestations and pathological examination.At present，there is no unified and effective treatment regimen. Hormone shock，reducing or terminating the dosage of immunosuppressants and preventing infection may be effective treatment methods.

Key words: Graft-versus-host disease, Liver transplantation, Steroids therapy, Immunosuppressant