title: Graft-verse-host disease after liver transplantation: a report of two cases and review of literature.
abstract: Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In mainland China, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.
authors.affiliation: Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Guo
authors.forename: Xiao-Shun
authors.initials: XS
authors.lastname: He
authors.forename: Lin-Wei
authors.initials: LW
authors.lastname: Wu
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Zhu
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Ju
authors.forename: Dong-Ping
authors.initials: DP
authors.lastname: Wang
authors.forename: Shen
authors.initials: S
authors.lastname: You
authors.forename: Yi
authors.initials: Y
authors.lastname: Ma
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Wang
authors.forename: Jie-Fu
authors.initials: JF
authors.lastname: Huang
mesh_terms: D002681:China; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics / Q000276:immunology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged