Successful outcome of acute graft-versus-host disease in a liver allograft recipient by withdrawal of immunosuppression.
BACKGROUND
Graft-versus-host disease (GVHD) after liver transplantation is uncommon, and the outcome is almost always fatal. Since 1987, about 30 cases have been described, and patient survival is mostly exceptional.


METHODS
A 29-year-old man underwent retransplantation due to chronic cholestatic syndrome, 5 years after his first liver transplantation. Indication for the first liver transplantation was acute liver failure caused by exsiccosis. After the second transplantation, the patient had an initially uneventful course, developing thrombocytopenia at day 21 followed by skin rash and septic complications. Diagnosis of acute GVHD was made by using serological techniques for HLA-A and HLA-DRB and subsequently by fluorogenic sequence-specific primed polymerase chain reaction. In addition, donor lymphocytes were marked by immunohistochemical methods via biopsies of the skin. Immunosuppressive therapy was withdrawn to allow the patient's own immune system to eliminate donor cells.


RESULTS
By withdrawing the immunosuppressive therapy, clinical and morphological signs of GVHD vanished. The patient is doing well without recurrence 13 months after transplantation.


CONCLUSIONS
Withdrawal of immunosuppressive therapy is a promising approach in the treatment of acute GVHD to allow the patient's immune system to reconstitute itself, reject offending lymphocytes, and avoid lethal septic complications.
Lehner
F
F
Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.
Becker
T
T
Sybrecht
L
L
Lück
R
R
Schwinzer
R
R
Slateva
K
K
Blasczyk
R
R
Hertenstein
B
B
Klempnauer
J
J
Nashan
B
B
D000208:Acute Disease; D000328:Adult; D006086:Graft vs Host Disease / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents