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 language | English |
|---|---|
| Pages (from-to) | 394-396 |
| Number of pages | 3 |
| Journal | Progress in Transplantation |
| Volume | 26 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2016 Jan 1 |
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Keywords
- Graft-versus-host disease
- Human leukocyte antigen
- Living donor liver transplantation
- Nonhomozygous
- Related body regions
- Transplant donor
ASJC Scopus subject areas
- Transplantation
Cite this
Fatal graft-versus-host disease following adult-to-adult living donor liver transplantation from an HLA nonhomozygous donor. / Yu, Young-Dong; Kim, Dong-Sik; Ha, Neul; Jung, Sung Won; Han, Jae Hyun; Kim, Joo Young; Park, Sung Hwan; Cho, Yunjung.
In: Progress in Transplantation, Vol. 26, No. 4, 01.01.2016, p. 394-396.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Fatal graft-versus-host disease following adult-to-adult living donor liver transplantation from an HLA nonhomozygous donor
AU - Yu, Young-Dong
AU - Kim, Dong-Sik
AU - Ha, Neul
AU - Jung, Sung Won
AU - Han, Jae Hyun
AU - Kim, Joo Young
AU - Park, Sung Hwan
AU - Cho, Yunjung
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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.
AB - 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.
KW - Graft-versus-host disease
KW - Human leukocyte antigen
KW - Living donor liver transplantation
KW - Nonhomozygous
KW - Related body regions
KW - Transplant donor
UR - http://www.scopus.com/inward/record.url?scp=85014310748&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014310748&partnerID=8YFLogxK
U2 - 10.1177/1526924816664087
DO - 10.1177/1526924816664087
M3 - Article
C2 - 27555077
AN - SCOPUS:85014310748
VL - 26
SP - 394
EP - 396
JO - Progress in Transplantation
JF - Progress in Transplantation
SN - 1526-9248
IS - 4
ER -