Clinical immune tolerance after healing of acute graft-versus-host disease following liver transplantation:one case report / 中华器官移植杂志

ABSTRACT

Objective A successful salvage treatment of acute graft-versus-host disease (GVHD) after liver transplantation(OLT) with prognosis of immune tolerance was reported and the treatment experience was summed up.Methods A 46-year-old man with hepatic carcinoma recurrence after resection underwent OLT from an ABO-identical male donor after cardiac death due to brain death.Post-transplant immunosuppression regimens consisted of induction with anti-interleukin-2 receptor monoclonal antibody (basiliximab) followed by maintenance with tacrolimus,mycophenolate mofetil and low dose of steroids.On the postoperative day (POD) 20,the patient developed skin rashes on his limbs and trunk,and skin biopsy showed histological features consistent with acute GHVD.Donor-recipient dominant HLA was matched at 6 loci,with donor CD3 + T-cell chimerism positive Results Immunosuppressants were withdrawn.Basilixirnab combined with high dose of steroids was used,and the dosage was quickly reduced.Anti-irnfection treatment was strengthened.The skin rash recovered quickly,while the hemogram was significantly decreased,which was insensitive to colony stimulating factor.The fever came back with the skin rash on the POD 46.The modified hormone regimen was used,low dose of steroids with slowly reduction,and the patient recovered with the normal hepatic function.Conclsion With the untypical clinical presentation,pathological examination,HLA-matching and chimerisms,aGVHD could be early detected and diagnosed,with a therapy of low dose of steroids with slow reduction combined with basiliximab.Recipient achieved immune tolerance,which may result from the high match of HLA and chimerisms.