Treatment of liver transplant graft-versus-host disease with antibodies against tumor necrosis factor-α
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Treatment of liver transplant graft-versus-host disease with antibodies against tumor necrosis factor-α. / Blank, Gregor; Li, Jun; Kratt, Thomas; Handgretinger, Rupert; Königsrainer, Alfred; Nadalin, Silvio.
in: CLIN TRANSPLANT, Jahrgang 11, Nr. 1, 01.02.2013, S. 68-71.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung
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TY - JOUR
T1 - Treatment of liver transplant graft-versus-host disease with antibodies against tumor necrosis factor-α
AU - Blank, Gregor
AU - Li, Jun
AU - Kratt, Thomas
AU - Handgretinger, Rupert
AU - Königsrainer, Alfred
AU - Nadalin, Silvio
PY - 2013/2/1
Y1 - 2013/2/1
N2 - Acute graft-versus-host disease is uncommon after liver transplant. We recently treated a 60-year-old man with liver transplant for hepatocellular carcinoma. After the primary liver transplant graft did not function, revision liver transplant resulted in excellent function. Subsequently, the patient developed watery diarrhea, systemic inflammatory response syndrome, a skin rash on his limbs and trunk, and palmar erythema. Skin biopsy suggested viral exanthems consistent with cytomegalovirus. Despite treatment for cytomegalovirus, intestinal symptoms worsened. Analysis of peripheral blood with fluorescence-activated cell sorting showed a high proportion of T lymphocytes, with 5% to 10% T cells specific to the second donor, suggestive of graft-versus-host disease. Within 48 hours after beginning therapy with antibodies against tumor necrosis factor-α (infliximab), the skin rash disappeared and endoscopy showed slight improvement of the mucosal regeneration. However, despite antifungal prophylaxis with caspofungin, the patient developed angioinvasive pulmonary aspergillosis and multiple organ failure, and he died. In conclusion, typical clinical symptoms of graft-versus-host disease after liver transplant may include skin rash and gastrointestinal symptoms, and diagnosis may be confirmed by histologic examination and testing for blood chimerism. A consensus for the treatment of graft-versus-host disease still is lacking, but tumor necrosis factor-α is an encouraging target for therapy to decrease the symptoms of graft-versus-host disease and enable mucosal regeneration.
AB - Acute graft-versus-host disease is uncommon after liver transplant. We recently treated a 60-year-old man with liver transplant for hepatocellular carcinoma. After the primary liver transplant graft did not function, revision liver transplant resulted in excellent function. Subsequently, the patient developed watery diarrhea, systemic inflammatory response syndrome, a skin rash on his limbs and trunk, and palmar erythema. Skin biopsy suggested viral exanthems consistent with cytomegalovirus. Despite treatment for cytomegalovirus, intestinal symptoms worsened. Analysis of peripheral blood with fluorescence-activated cell sorting showed a high proportion of T lymphocytes, with 5% to 10% T cells specific to the second donor, suggestive of graft-versus-host disease. Within 48 hours after beginning therapy with antibodies against tumor necrosis factor-α (infliximab), the skin rash disappeared and endoscopy showed slight improvement of the mucosal regeneration. However, despite antifungal prophylaxis with caspofungin, the patient developed angioinvasive pulmonary aspergillosis and multiple organ failure, and he died. In conclusion, typical clinical symptoms of graft-versus-host disease after liver transplant may include skin rash and gastrointestinal symptoms, and diagnosis may be confirmed by histologic examination and testing for blood chimerism. A consensus for the treatment of graft-versus-host disease still is lacking, but tumor necrosis factor-α is an encouraging target for therapy to decrease the symptoms of graft-versus-host disease and enable mucosal regeneration.
KW - Antibodies
KW - Antibodies, Monoclonal
KW - Carcinoma, Hepatocellular
KW - Fatal Outcome
KW - Graft vs Host Disease
KW - Humans
KW - Liver Neoplasms
KW - Liver Transplantation
KW - Male
KW - Middle Aged
KW - Multiple Organ Failure
KW - Pulmonary Aspergillosis
KW - Treatment Outcome
KW - Tumor Necrosis Factor-alpha
M3 - SCORING: Journal article
C2 - 23387543
VL - 11
SP - 68
EP - 71
JO - CLIN TRANSPLANT
JF - CLIN TRANSPLANT
SN - 0902-0063
IS - 1
ER -