Fatal graft-versus-host disease following adult-to-adult living donor liver transplantation from an HLA nonhomozygous donor

Young Dong Yu, Dong Sik Kim, Neul Ha, Sung Won Jung, Jae Hyun Han, Joo Young Kim, Sung Hwan Park, Yun Jung Cho

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    3 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)394-396
    Number of pages3
    JournalProgress in Transplantation
    Volume26
    Issue number4
    DOIs
    Publication statusPublished - 2016 Dec

    Keywords

    • Graft-versus-host disease
    • Human leukocyte antigen
    • Living donor liver transplantation
    • Nonhomozygous
    • Related body regions
    • Transplant donor

    ASJC Scopus subject areas

    • Transplantation

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