title: Unusual onset of chronic graft-versus-host disease after adult living-related liver transplantation from a homozygous donor.
abstract: Graft-versus-host disease (GVHD) is a rare complication that occurs after living-related liver transplantation (LRLT). This condition usually occurs early after transplantation and is fatal. Although one-way matching between a human leukocyte antigen (HLA)-homozygous donor and a haploidentical recipient has been shown to be a significant risk factor for the development of acute GVHD, chronic GVHD has not been clarified. A 50-year-old woman underwent LRLT for primary biliary cirrhosis with her 32-year-old HLA-homozygous son as the donor. The patient developed chronic GVHD 114 days posttransplant, presenting with a skin rash only. Her atypical onset included neither fever nor gastrointestinal symptoms. The patient responded to corticosteroid therapy and is now doing well at home. Careful donor selection and HLA matching before LRLT should be performed to prevent GVHD. However, the risks associated with grafts from homozygous donors may be unavoidable at present because of the shortage of cadaveric donors in Japan.
authors.affiliation: Liver Transplant Team, Department of Surgery, Dokkyo University School of Medicine, Tochigi, Japan. t-nemoto@dokkyomed.ac.jp
authors.forename: Takehiko
authors.initials: T
authors.lastname: Nemoto
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.forename: Junji
authors.initials: J
authors.lastname: Kita
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Kyu
authors.initials: K
authors.lastname: Rokkaku
authors.forename: Nobumi
authors.initials: N
authors.lastname: Tagaya
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sunakawa
mesh_terms: D000284:Administration, Oral; D000328:Adult; D002908:Chronic Disease; D003872:Dermatitis / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy; D006680:HLA Antigens / Q000235:genetics*; D006720:Homozygote; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged
chemical_list: D005938:Glucocorticoids; D006680:HLA Antigens; D008775:Methylprednisolone