Treatment of graft-versus-host disease after liver transplantation with basiliximab followed by bowel resection.
Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a serious complication with mortality rates over 80%. Two patients with established GVHD after OLT were treated with Basiliximab, a chimeric murine human monoclonal antibody which binds to the alpha-chain of interleukin-2 receptor (IL-2R). Two males, aged 45 and 56 years, presented after OLT with a clinical picture consistent with GVHD. Quantitative measurements of recipient peripheral blood donor lymphocyte chimerism were carried out by flow cytometric analysis, and showed peak chimerism levels of 5% and 8%, respectively. Treatment comprised 3 doses of 1 g methyl prednisolone followed by 2 doses of 20 mg of Basiliximab. In both, treatment resulted in complete disappearance of macro-chimerism in blood. There was resolution of skin rash by day 7; however, diarrhea persisted. White cell scan showed increased uptake in the terminal ileum and small-bowel resection was performed in both patients. One patient is alive and well 36 months after OLT. The other patient had resolution of GVHD, but died of recurrent hepatitis C 1 year after OLT. The combination of immunological and surgical treatment for GVHD following solid organ transplantation has not previously been described.
Sudhindran
S
S
Departments of Transplantation, Department of Histopathology, and Department of Tissue Typing, Addenbrooke's NHS Trust, Cambridge, UK.
Taylor
A
A
Delriviere
L
L
Collins
V P
VP
Liu
L
L
Taylor
C J
CJ
Alexander
G J
GJ
Gimson
A E
AE
Jamieson
N V
NV
Watson
C J E
CJ
Gibbs
P
P
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000077552:Basiliximab; D005434:Flow Cytometry; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D017404:In Situ Hybridization, Fluorescence; D007421:Intestine, Small / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011993:Recombinant Fusion Proteins
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab