Table 3.
Treatment modalities used for treatment of post liver transplant GVHD.
| Therapy | Reference | Age/ sex |
GVHD onset |
Symptoms | Outcome | Cause of death |
|---|---|---|---|---|---|---|
| Abatacept | Elfeki et al [7] | 60 yr/M |
POD 26 | Skin rash, diarrhea, fever |
Pt. survived |
|
| MP, ATG | Chaib et al [6] | 64 yr/M |
POD 31 | Skin rash, fever, maculopapular eruptions, diarrhea leukopenia, |
Pt. died POD 36 |
Multiple organ failure |
| ATG Alefacept Rituximab HCT |
Rogulj et al [9] | 53 yr/F |
POD 38 | Tremors, headache, forgetfulness, difficulty in word finding |
Pt. died POD 86 |
Septicemia, Aspergillosis, RDS |
| ATG | Perri et al [4] | 59 ye/F |
POD 24 | Fever, rash | Pt. died POD 38 |
Invasive Aspergillosis |
| ATG Basiliximab |
Perri et al [4] | 66 yr/F |
POD 35 | Fever, rash | Pt. died POD 126 |
Respiratory failure |
| MP | Perri et al [4] | 55 yr/M |
POD 23 | Fever, rash | Pt. died POD 41 |
Sepsis |
| ATG | Perri et al [4] | 48 yr/F |
POD 34 | Fever, rash, pancytopenia |
Pt. died POD 385 |
Aspiration pneumonia |
| ATG Basiliximab |
Perri et al [4] | 64 yr/M |
POD 27 | Fever, diarrhea, leukopenia |
Pt. died POD 293 |
Invesive Aspergillosis |
| Tacrolimus, MP ATG |
Calmus et al [45] | 48 yr/M |
POD 35 | Fever, diarrhea | Pt. died POD 61 |
Pneumonia |
| HCT | Pollack et al [14] | 52 yr/M |
8 months after transplant |
Oral thrush, skin rash, fever, diarrhea |
Pt. died 5 days after HCT |
Candida kruseii infection, multi-organ failure |
| Basiliximab, bowel resection |
Sudhindram et al [30] | 45 yr/M |
POD 24 | Fever, rash and vesicular lesion |
Pt. survived |
|
| Basiliximab | Sudhindram et al [30] | 56 yr/M |
POD 31 | Maculopapular rash, diarrhea |
9 months after OLT |
Recurrent fibrosing hepatitis |
| Reduced immunosuppression |
Chinnakotla et al [47] | 58 yr/M |
10 weeks post OLT |
Skin rash | Pt. Survived |
|
| Reduced immunosuppression |
Chinnakotla et al [47] | 52 yr /M |
18 weeks post OLT |
Fever, neutropenia |
Pt. survived |
|
| Reduced immune– suppression, ATG |
Chinnakotla et al [47] | 62 yr /M |
2 weeks post OLT |
Generalized rash |
Pt. died POD 63 |
Bacterial sepsis |
| Etanercept | Thin et al [10] | 65 yr/M |
Pod 20 | Rigors, pancytopenia |
Pt. survived |
|
| FK506, MP |
Zhang et al [38] | 53 yr/M |
POD 26 | Fever, rash, diarrhea, pancytopenia |
Pt. died POD 46 |
Septicemia, RDS, multiple organ failure |
| Basiliximab Cyclosporine A ATG, OKT3 |
Kohler et al [8] | 30 yr/M |
POD 42 | Fever, skin rash | Pt. died POD 54 |
Cerebral hemorrhage |
| MP, ATG, OKT3, plasmapheresis |
Kohler et al [8] | 44 yr/F |
POD 20 after re– transplant |
Skin rash | Pt. died POD 31 after re– transplant |
Sepsis, multi-organ failure |
| MP, ATG | Kohler et al [8] | 61 yr/M |
POD 60 | Skin rash, fever | Pt. died POD 88 |
Multi-organ failure |
| None | Kohler et al [8] | 64 yr/F |
POD 35 | Intracranial bleeding, skin rash |
Pt. died POD 47 |
Pancytopenia, multi-organ failure, septic shock |
| MP | Kohler et al [8] | 67 yr/M |
POD 34 | Skin rash, hypotension, weakness |
Pt. died POD 39 |
Sepsis, multi-organ failure |
| Tacrolimus, mycophenolate |
Yilmaz et al [60] | 49yr/ M |
POD 22 | Elevated liver enzyme, skin rash |
Pt. died POD 8 months |
Multi-organ failure |
Note: In most post-transplant cases initial immunosuppression was done with tacrolimus, mycophenolate mofetil and corticosteroid. Sepsis and multiple organ failure are the main reason for patient death. ATG: Anti-thymocyte globulin; MP: methylprednisolone; RDS: Respiratory distress syndrome; HCT: Hematopoietic Stem Cell transfusion; OLT: orthotropic liver transplant; POD: post-operative day.