Ann Liver Transplant.  2024 Nov;4(2):56-62. 10.52604/alt.24.0003.

Graft-versus-host disease in liver transplantation: Experience in the Korean single center

• Koh HH
• Kim DG
• Kang M
• Min EK
• Lee JG
• Joo DJ
• Kim MS

• KMID: 2561849
• DOI: http://doi.org/10.52604/alt.24.0003

Abstract

Background
This investigation delves into the intricacies of graft-versus-host disease (GVHD) in the context of liver transplantation (LT), focusing on the experiences from a Korean single center. Despite GVHD’s relatively low incidence, its severe implications on patient mortality underscore the urgent need for advanced management and comprehension strategies.
Methods
In a retrospective analysis at Severance Hospital, Korea, we reviewed 1,107 adult LT recipients from January 2009 to March 2023, excluding those who succumbed within 14 days post-transplantation, to scrutinize the manifestation, treatment, and outcomes of GVHD. Diagnostic approaches ranged from skin to colonoscopic biopsies, with interventions including high-dose corticosteroids and tailored immunosuppressive adjustments.
Results
GVHD was diagnosed in 1.3% of the study cohort, predominantly identified through skin biopsies. Critical findings include the significant role of donor liver characteristics and recipient pre-transplant conditions in GVHD development. Notably, GVHD affected patients exhibited markedly lower survival rates at one year compared to their non-GVHD controls (21.4% vs. 90.2%, p<0.001), with deceased donor liver transplants and human leukocyte antigen one-way mismatches between donor and recipient identified as significant GVHD risk factors.
Conclusion
This study reaffirms the severe impact of GVHD on post-LT patient survival and highlights specific risk factors associated with its development. Enhanced understanding and targeted management of these risk factors are crucial for improving outcomes for LT recipients facing this complex complication.

Keyword

Graft-versus-host disease; Liver transplantation; Treatment

Figure

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  Figure 1 Comparison of 1 year patient survival by development of graft-versus-host disease (GVHD). (A) Before propensity score matching (PSM), (B) after PSM. LT, liver transplantation.

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