Clinical and pathological features of graft-versus-host disease after liver transplantation: A case report and review of the literature

A 59-year-old female developed symptoms of graft-versus-host disease 3 1/2 weeks after liver transplantation for primary biliary cirrhosis. Symptoms of graft-versus-host disease included fever, erythroderma with bullae formation, and mucosal surface ulceration. Donor lymphocytes were present in the peripheral blood. Despite treatment with equine antilymphoblast globulin, steroids and, eventually, cyclosporine withdrawal, she developed neutropenia and succumbed to sepsis. At autopsy, she had marked lymphocyte depletion involving the bone marrow and both native and donor origin lymph nodes. As expected, the liver was normal. The clinical and pathological features were remarkably similar to those of the few other reported cases of graft-versus-host disease after liver transplantation and transfusion-associated graft-versus-host disease; therapy is usually ineffective, and progression of disease leads to pancytopenia and death from sepsis.