Haploidentical hematopoietic stem cell transplantation for graft-versus-host disease after liver transplantation.

摘要

A 74-year-old woman with hepatitis C and hepatocellular carcinoma underwent deceased donor liver transplant (LT) from a male donor in August 2008. Donor and recipient were blood group A~+ and 2-loci HLA matched (DR01 and DR15). Initial immunosuppres-sion included a corticosteroid taper and tacrolimus. On postoperative day (POD) 28, she developed a papular erythematous rash, diarrhea, and neutropenia. Skin biopsy showed perivascular lympho-cytic infiltrate with necrotic keratinocytes and full thickness epidermal necrosis. FISH analysis demonstrated XY-chimerism in both peripheral blood (29.2%) and skin (18.5%, 37/200 nuclei) consistent with graft-versus-host disease (GVHD). Bone marrow biopsy showed < 10% cellularity with XY chimerism (2/10 nuclei) on karyotype analysis. Liver function tests were normal. High dose steroids and mycophenolate mofetil 500mg TID were added. The patient developed refractory neutropenia and thrombocytopenia. After failing a trial of IVIG (0.5mg/kg/d) and rabbit anti-thymocyte globulin (rATG; 1.5mg/kg/d), we sought a donor for rescue hematopoietic stem cell transplantation (HSCT) based on prior success with this strategy in GVHD following HSCT.