GRAFT-VERSUS-HOST DISEASE IN A LIVER-TRANSPLANT RECIPIENT

Thirty-five days after an orthotopic liver transplant, a patient developed fever; a skin rash involving the trunk, face, palms, and soles; pancytopenia; and diarrhea. A skin biopsy showed histologic findings consistent with acute graft-versus-host disease. HLA typing of circulating peripheral blood lymphocytes showed complete donor chimerism and established the diagnosis of liver allograft-induced graft-versus-host disease. The patient died despite treatment with large doses of corticosteroids. Although graft-versus-host disease in this setting appears lo be infrequent, it is possible that the syndrome is under-recognized. Because of the increasing frequency with which orthotopic liver transplantation is being done, careful prospective study to determine the incidence and spectrum of the syndrome is warranted.