title: Solid-Organ Graft-Versus-Host Disease After Liver Transplant: A Case Report.
abstract: Solid-organ transplant graft-versus-host disease (SOT-GVHD) is a rare complication of organ transplant that is associated with high mortality. The initial signs and symptoms are vague, so this disease is easily confused with other posttransplant complications. A case of SOT-GVHD occurred after orthotopic liver transplant for liver failure due to hepatitis C in a patient in a Veterans Affairs intensive care unit. The patient had dehydration, acute kidney injuries, rashes, diarrhea, and pancytopenia. Results of skin biopsy, bone marrow biopsy, and cytogenetic studies were consistent with SOT-GVHD. Despite supportive care including antibiotics, antiviral and antifungal therapy, high-dose steroids, antithymoglobulin and neupogen, the patient died of overwhelming sepsis. Owing to the rarity of SOT-GVHD, no evidence-based guidelines or recommendations for treatment exist. Treatment includes high-dose corticosteroids and antibiotic, antifungal, and antiviral prophylaxis. Treatment of liver transplant-related GVHD with anti-tumor necrosis factor a agents has been successful.
authors.affiliation: Jonathan S. Auerbach is a critical care intensivist at Boca Raton Regional and Bethesda Hospitals and is an affiliate assistant professor of clinical biomedical science in the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.Christopher K. Schott is on staff at VA Pittsburgh Health Care Systems and is an assistant professor of critical care and emergency medicine, director of critical care ultrasonography, and director of the medical student critical care elective at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Auerbach
authors.affiliation: Jonathan S. Auerbach is a critical care intensivist at Boca Raton Regional and Bethesda Hospitals and is an affiliate assistant professor of clinical biomedical science in the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.Christopher K. Schott is on staff at VA Pittsburgh Health Care Systems and is an assistant professor of critical care and emergency medicine, director of critical care ultrasonography, and director of the medical student critical care elective at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. schottck@upmc.edu.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Schott
mesh_terms: D000368:Aged; D018450:Disease Progression; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D035583:Rare Diseases; D018570:Risk Assessment