title: Graft versus host disease as a complication after liver transplantation: A rare but serious association.
abstract: The graft versus host disease after liver transplant is rare, with an incidence less than 1%, but with a high mortality (75-85%), especially due to infectious complications. It usually affects gastrointestinal tract, skin and blood system in the context of a normal liver graft function. There is no consensus on the most appropriate treatment: some articles support a reduction or even elimination of immunosuppressive drugs, while others published success with a dose increase.
  
  
  METHODS
  We report a case of a 68 year-old liver transplant recipient with a graft retrieved from an ABO identical cadaveric donor. After an uneventful postoperative period, he was readmitted presenting these symptoms: skin lesions, diarrhea and kidney failure. After ruling out infectious causes or drug toxicity, skin, duodenum and colon biopsies demonstrated characteristic histological changes of graft versus host disease grade III. Initially, supportive treatment along with methylprednisolone bolus were administered with good response. However, as the doses of corticosteroids decreased, the patient worsened again, requiring basiliximab. In spite of that, the patient progressively worsened with hematological involvement and, finally, an alteration of liver function tests prior to decease. The autopsy showed CMV and Herpes virus superinfection.
  
  
  CONCLUSIONS
  We report a new case of graft-versus-host disease after liver transplantation with fatal evolution due to viral superinfection despite the employed measures.
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Rio Hortega, España.
authors.forename: Baltasar
authors.initials: B
authors.lastname: Pérez-Saborido
authors.affiliation: Unidad de Trasplante Hepático/Servicio de Cirugía , Hospital Universitario Rio Hortega, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Asensio-Díaz
authors.affiliation: Servicio de Cirugía General, Hospital Universitario Rio Hortega, España.
authors.forename: Asterio
authors.initials: A
authors.lastname: Barrera-Rebollo
authors.affiliation: Servicio de Cirugía General, Hospital Universitario Rio Hortega, España.
authors.forename: Mario
authors.initials: M
authors.lastname: Rodríguez-López
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario Rio Hortega, Valladolid, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Gonzalo-Martín
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario Rio Hortega, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Madrigal-Rubiales
authors.affiliation: Servicio de Aparato Digestivo. Unidad de Hepatolog, Hospital Universitario Rio Hortega, España.
authors.forename: Félix
authors.initials: F
authors.lastname: García-Pajares
authors.affiliation: Unidad de Trasplante Hepático, Hospital Universitario Rio Hortega, España.
authors.forename: David
authors.initials: D
authors.lastname: Pacheco-Sánchez
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D003586:Cytomegalovirus Infections / Q000150:complications; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D000077552:Basiliximab