Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers.

Objective The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT). Methods Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated. Results There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications. Conclusion GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.