title: Graft-versus-Host Disease after Liver Transplantation: A Single-Center Case Series.
abstract: BACKGROUND
  Graft versus host disease (GVHD) is a rare complication following liver transplantation (LT) and has high mortality. We describe our single-center experience with 6 cases of GVHD diagnosed over a period of 14 years in a total of 604 liver transplant recipients--283 deceased donor liver transplants (DDLT) and 321 living-related liver transplants (LDLT).
  
  
  METHODS
  We report a case series of 6 patients with acute GVHD after liver transplantation from May 2001 to December 2014. Five cases were males; age 51-67 years (average 61). The time from transplantation until clinical presentation of GVHD ranged from 36 to 140 days, with average duration of 72 days. All cases had diarrhea and pancytopenia, 4 out of 5 presented with erythematous skin rashes, and 2 had cytomegalovirus colitis. GVHD was confirmed by skin biopsies, engraftment profile from bone marrow biopsy, and sigmoid colon biopsy. Treatment strategies included use of corticosteroids in 4 cases, stopping immunosuppression in 1 case, and no treatment in 1 case with mild disease. Five patients died between 18 to 65 days from clinical presentation (average 43 days) and 1 patient with mild GVHD is doing well 290 days after clinical presentation.
  
  
  CONCLUSIONS
  GVHD is a rare complication after liver transplantation that needs a high index of suspicion in patients who develop rash, diarrhea, or sever pancytopenia. There is no consensus on the best treatment regimen and mortality remains high.
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Hussien
authors.initials: H
authors.lastname: Elsiesy
authors.affiliation: Department of Medicine, Gastroenterology Section, Alexandria University, Alexandria, Egypt.
authors.forename: Abeer
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Khaled
authors.initials: K
authors.lastname: Selim
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Sebayel
authors.affiliation: Organ Transplant Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Dieter
authors.initials: D
authors.lastname: Broering
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al Hamoudi
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Rania
authors.initials: R
authors.lastname: Al Arieh
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
mesh_terms: D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents