Acute graft-versus-host disease of the lung after liver transplantation.
We describe the first case of a man who developed acute graft-versus-host disease (GVHD), isolated to the lung, after an orthotopic liver transplant from a female donor. Our patient experienced dyspnea, worsening hypoxemia, and a progressive obstructive ventilatory defect 12 days after liver transplantation. Open-lung biopsy revealed grade 2 lymphocytic bronchiolitis, the pathologic and immunologic correlate of acute pulmonary GVHD. Fluorescent in situ hybridization confirmed donor cells at sites of peribronchiolar inflammation. High-dose corticosteroids were given with a return to baseline pulmonary function. The current case should alert clinicians to investigate pulmonary GVHD as a potential cause of postoperative dyspnea in liver transplant recipients.
D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D001991:Bronchitis / Q000209:etiology / Q000473:pathology; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007275:Injections, Intravenous; D016031:Liver Transplantation / Q000009:adverse effects*; D008171:Lung Diseases / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone