Graft-versus-host disease and liver transplantation – It can be survived

Abstract

Background: Graft-versus-host disease (GVHD) following orthotopic liver transplantation (OLT) is a rare but deadly complication. Several risk factors have been mentioned by different authors over the past years. Methods: A 63 year old male presented with fever and fatigue 3 months after OLT. After merely fast progression of the symptoms and worsening of condition despite antibiotic application of Meronem, the patient was transferred to our intensive care unit. The patient developed mucosal lesions as well as a generalized exanthema. After Stevens-Johnson-Syndrome could be ruled out, skin lesions were treated with local steroids and in addition systemic methyl-prednisolone in combination with cyclosporine was administered. Under this regime the patient improved steadily. Results: The patient could be stabilized and eventually be dismissed from our hospital. Biopsy of skin and colon confirmed the diagnosis of GVHD. Conclusion: Our case represents one of the few patients described in current literature to actually survive this complication. The prevention of GVHD seems highly important since most treatment regimes are reported as not successful. We have experienced a case of acute GVHD following adult-to-adult OLT with a positive outcome. According to the literature high-dose steroids in combination with calcineurin inhibitors are ineffective in the treatment of GVHD after OLT. Nevertheless, in our case steroids continously tapered down in addition with cyclosporin seemed to be effective in treating this complication.