title: Fatal Graft-Versus-Host Disease Following Adult-To-Adult Living Donor Liver Transplantation From an HLA Nonhomozygous Donor.
abstract: The use of a human leukocyte antigen (HLA) homozygous donor to a haploidentical recipient is a well-documented cause of transfusion-associated graft-versus-host disease (GVHD). Several authors have reported that use of a graft from an HLA-homozygous donor with 1-way donor-recipient HLA matching led to an extremely high risk of developing GVHD in LDLT. We have experienced a fatal case of acute GVHD following adult-to-adult LDLT from a donor who was heterozygous at a single HLA locus. A 53-year-old female underwent LDLT for chronic hepatitis B and recurrent hepatocellular carcinoma. The donor was her 23-year-old son. The HLA phenotype of the donor was not homozygous (A24, -; B54, -; DR4, 9) and revealed one-way donor-dominant HLA matching at two loci with the recipient (A2, 24; B48, 54; DR4, 12). On the fortieth postoperative day, the patient showed erythematous skin lesions. Skin biopsy revealed typical findings of GVHD. Donor-derived chimerism was demonstrated by performing fluorescent in situ hybridization (FISH) using the recipient's skin tissue. As the clinical course deteriorated, etanercept was started in addition to broad-spectrum antibiotics but there was no improvement. As multi-organ failure progressed, the patient succumbed to death on the 54th postoperative day, which was 2 weeks after onset of GVHD. The prevention of GVHD is more important since the results of treatment have been disappointing. We have experienced a fatal case of acute GVHD following adult-to-adult LDLT from a HLA non-homozygous donor. HLA heterozygosity at a single locus does not preclude the possibility of developing GVHD following adult-to-adult LDLT.
authors.affiliation: 1 Division of HBP surgery and Liver transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea.
authors.forename: Young-Dong
authors.initials: YD
authors.lastname: Yu
authors.affiliation: 1 Division of HBP surgery and Liver transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea.
authors.forename: Dong-Sik
authors.initials: DS
authors.lastname: Kim
authors.affiliation: 1 Division of HBP surgery and Liver transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea.
authors.forename: Neul
authors.initials: N
authors.lastname: Ha
authors.affiliation: 1 Division of HBP surgery and Liver transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea.
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jung
authors.affiliation: 1 Division of HBP surgery and Liver transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea.
authors.forename: Jae-Hyun
authors.initials: JH
authors.lastname: Han
authors.affiliation: 2 Department of Pathology, Korea University Medical Center, Seoul, Korea.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: 3 Department of Forensic Medicine, Korea University Medical Center, Seoul, Korea.
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Park
authors.affiliation: 4 Department of Laboratory Medicine, Korea University Medical Center, Seoul, Korea.
authors.forename: Yun-Jung
authors.initials: YJ
authors.lastname: Cho
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged
chemical_list: D006680:HLA Antigens
keywords: graft-versus-host disease; human leukocyte antigen; living donor liver transplantation; nonhomozygous; related body regions; transplant donor