Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 14, 2008; 14(6): 974-979
Published online Feb 14, 2008. doi: 10.3748/wjg.14.974
Graft-verse-host disease after liver transplantation: A report of two cases and review of literature
Zhi-Yong Guo, Xiao-Shun He, Lin-Wei Wu, Xiao-Feng Zhu, Wei-Qiang Ju, Dong-Ping Wang, Shen You, Yi Ma, Guo-Dong Wang, Jie-Fu Huang
Zhi-Yong Guo, Xiao-Shun He, Lin-Wei Wu, Xiao-Feng Zhu, Wei-Qiang Ju, Dong-Ping Wang, Shen You, Yi Ma, Guo-Dong Wang, Jie-Fu Huang, Organ Transplantation center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Correspondence to: Dr. Xiao-Shun He, Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University, No 58 Zhongshan Er Lu, Guangzhou 510080, Guangdong Province, China. gdtrc@163.com
Telephone: +86-20-87306082
Fax: +86-20-87306082
Received: August 23, 2007
Revised: October 11, 2007
Published online: February 14, 2008
Abstract

Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In mainland China, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.

Keywords: Graft-versus-host disease; Liver transp-lantation; Prognosis; Diagnosis; Treatment