Split-Liver Transplantation in a Child with Liver Failure Based on Chronic Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation from the Same Donor.

Abstract

We report a case of a 6-year-old boy who developed chronic graft-versus-host-disease (GVHD) of the liver, the intestines and the skin following allogeneic hematopoietic stem cell transplantation.The boy received allogeneic hematopoietic stem cell transplantation by the age of two years because of early recurrence of acute lypmphoblastic leukemia. The chimerism analysis showed complete chimerism. In the following year he developed GVHD despite adequate immunosuppressive therapy. Liver biopsy showed liver-GVHD resulting in liver cirrhosis by the age of five years.Liver transplantation was performed with a split liver segment from the same unrelated donor as of the stem cells. Immunosuppressive therapy consisted of low dose steroids and low dose cyclosporine. The postoperative course was uneventful. Graft function was excellent and we performed protocol biopsies seven days and three weeks after transplantation which did not show any signs of rejection or GVHD.To our knowledge this is the first report on a liver transplantation following allogeneic hematopoietic stem cell transplantation from the same unrelated donor.In the latest liver biopsy three months after liver transplantation slight signs of GVHD could not be ruled out completely so that the low dose cyclosporine therapy is still continued.Further biopsies will show if the immunosuppressive therapy can be discontinued.