Fatal graft-versus-host disease after living-donor liver transplantation from an HLA-DR-mismatched donor
Keita Shimata
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorRieko Sakamoto
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorTadashi Anan
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorKoushi Uchida
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorMasaki Honda
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorMasahiko Kouroki
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorTomonari Urabe
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorShintaro Hayashida
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorHidekazu Yamamoto
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorCorresponding Author
Yasuhiko Sugawara
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Correspondence
Yasuhiko Sugawara, Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Email: [email protected]
Search for more papers by this authorYukihiro Inomata
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorKeita Shimata
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorRieko Sakamoto
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorTadashi Anan
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorKoushi Uchida
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorMasaki Honda
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorMasahiko Kouroki
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorTomonari Urabe
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorShintaro Hayashida
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorHidekazu Yamamoto
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorCorresponding Author
Yasuhiko Sugawara
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Correspondence
Yasuhiko Sugawara, Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Email: [email protected]
Search for more papers by this authorYukihiro Inomata
Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, Kumamoto, Japan
Search for more papers by this authorAbstract
Acute GVHD is a rare complication after liver transplantation that has a high mortality rate. We experienced an infant case complicated with acute GVHD. An 8-month-old infant with biliary atresia underwent LDLT with a graft obtained from his mother. Their HLAs showed a donor-dominant one-way match, not at HLA-DR but at HLA-A, HLA-B, and HLA-C (recipient; A 31/33, B 51/54, C 1/14, DR 9/11, donor; A 31/-, B 51/-, C 14/-, DR 8/11). The patient exhibited a high fever, skin rash, and diarrhea, and was diagnosed with acute GVHD based on the blood chimerism test. Despite immunosuppression treatment with prednisolone and tacrolimus, plasma exchange, blood transfusion including cord blood transplantation, and antibiotics, the child died on postoperative day 126. Donor-dominant one-way matching at HLA class 1 can be a high-risk factor for acute GVHD despite HLA class 2 mismatching.
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