M Markiewicz-Kijewska, J Teisseyre, P Kaliciński, P Kluge, M Teisseyre
Ann Transplant 2009; 14(1): 42-42
Background: Graft versus host disease after liver transplantation develops extremely rare, but always is a life threatening complication. In the literature we found about 85 cases reported until now that included 10 children. We report additional case of GvHD in a paediatric liver transplant recipient.
Case Report: 16 months old boy received living related donor (father) liver
transplantation after failed hapatoportoenterostomy due to congenital biliary atresia. Both, donor and recipient were of identical blood group and pre-transplant cross-match was negative. Primary immunosuppression consisted of tacrolimus and mycophenolate mofetil. Early post-transplant course was excellent, but after 7 weeks he developed mild upper respiratory distress which was treated with oral cephalosporin. Three days later he developed a skin rash followed by little blisters and ulcerative changes. There were no laboratory abnormalities but relative leucopenia, with increased number of eosinophils and CRP. Skin biopsy confirmed suspicion of graft versus host disease of grade II/III. Local therapy was introduced with colloid dressings and tacrolimus was discontinued, while corticosteroid boluses (5-10 mg/kg body mass) and daclizumab (1 mg/kg body mass) were started. Despite that, further deterioration was observed and we decided to treat the child with ATG, however the child died of MOF after next 9 days despite all possible intensive therapy.
Conclusions: GvHD is very serious complication with high mortality rate. There is no standard for the effective therapy of problem.
Keywords: Liver Transplantation, case report