Experience in diagnosis and treatment of acute graft-versus-host disease after liver transplantation of 8 cases

Objective To investigate the diagnosis and treatment of acute graft-versus-host disease ( aGVHD) after liver transplantation.Methods This report included 8 patients treated with liver transplantation who were admitted to the Liver Transplantation Center of Beijing YouAn Hospital from April 2011 to August 2016. The key points in the diagnosis of aGVHD and the experience in the treatment of this disease were summarized. Results The key points in the diagnosis of aGVHD after liver transplantation were as follows: ( 1) aGVHD usually occur at two weeks to two months after liver transplantation; ( 2) fever, rash, diarrhea, and reduced whole blood cell count are typical clinical symptoms; ( 3) the percentage of donor T lymphocytes in peripheral blood is more than 10%; ( 4) there are typical histopathological manifestations. The experience in the treatment of aGVHD after liver transplantation were as follows: the overall steroid response rate is 20%-50%, and methylprednisolone ( 1. 5 mg·kg-1·d-1, one week) is recommended; high-dose glucocorticoids are not recommended, thus avoiding increased infection risk; high-dose immunosuppressant is one of the causes of aGVHD, and excessive application of immunosuppressant should be avoided in clinical practice; the prevention of respiratory infection and digestive tract infection was very important; enteral nutrition should be considered; second-line therapies such as siplizumab, antithymocyte globulin, and tumor necrosis factor-alpha inhibitor may play a certain therapeutic role; blood purification can be used to effectively eliminate cytokines and inflammatory mediators, which is helpful to the treatment of aGVHD. Conclusion The diagnostic criteria for aGVHD after liver transplantation are mainly based on time of onset, clinical symptoms, peripheral blood T lymphocyte chimerism rate, and histopathology. Hormone shock and reducing the dose of immunosuppressant may be effective treatments.