High-Resolution (HR) HLATyping Can Confirm the Diagnosis of Graft Versus Host Disease (GVHD)After Orthotopic Liver-Transplantation (OLT)

Acute graft versus host disease (GVHD) following orthotopic liver transplantation (OLT) is a rare but severe disease. GVHD diagnosis can often be delayed, since the symptoms are non-specific. We present a case of a 62 year-old male with end-stage liver disease who underwent OLT. There were no major peri-transplant complications. Patient presented ~4 weeks post-OLT, with fever,cough, throat discomfort, and rash; and was treated for suspected infection with broad-spectrum antimicrobials. ~5 weeks post-OLT, patient became pancytopenic, and a skin biopsy was suspicious for GVHD. Bone marrow biopsy was performed and revealed extreme pancytopenia with necrosis. The individual pre-OLT patient and donor types were compared at the serologic equivalent and high-resolution (HR) HLA-type, without clear indication of risk for GVHD, and or graft rejection. HR HLA-typing was performed on bone marrow cells obtained post-OLT and compared with the pre-OLT specimen to demonstrate donor lymphoid chimerism. HR typing results from the patient’s bone marrow post-OLT indicated the presence of all four alleles, and along with the clinical features,confirmed the diagnosis of GVHD. This case demonstrates howHR HLA typing can aid in rapid diagnosis and early recognition of GVHD post-OLT.