title: Immunological basis for treatment of graft versus host disease after liver transplant.
abstract: Graft versus host disease (GVHD) after liver transplant, although a rare disease, has a very high mortality rate. GVHD occurs due to immunoreactions caused by donor T lymphocytes and host cell surface antigens resulting in proliferation and clonal expansion of T lymphocyte. Migration of effector cells, including macrophages, NK cells and cytotoxic T lymphocyte, to the target organs such as skin, intestine and bone marrow results in skin rashes, diarrhea and bone marrow depression. GVHD is diagnosed by clinical symptoms, histopathological findings and by the presence of chimerism. The delayed diagnosis, opportunistic infections and lack of definitive treatment of post orthotopic liver transplant (OLT)-GVHD results in sepsis and multi-organ failure leading to very low survival rates. In this review, we have focused on early diagnosis and critically discuss novel treatment modalities to decrease the incidence of GVHD.
authors.affiliation: a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Vikrant
authors.initials: V
authors.lastname: Rai
authors.affiliation: b Department of Pathology , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Nicholas Edward
authors.initials: NE
authors.lastname: Dietz
authors.affiliation: a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Agrawal
mesh_terms: D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D013997:Time Factors
keywords: Chimerism; Graft versus host disease; Immunoreactivity; Multi organ failure; Opportunistic infections; Sepsis; Surface antigens; T lymphocytes; liver transplant