Graft-versus-host disease after living donor liver transplantation: A collective review of Korean cases

Graft-versus-host disease (GVHD) occurs when donor lymphocytes recognize recipient cell surface antigens as foreign and react against them.Although GVHD is rare, it is a life-threatening complication.Following liver transplantation (LT), the incidence of GVHD is estimated to be 0.1% to 2%.However, more than 50% of affected patients have died.Living donor LT (LDLT) has a special risk of GVHD because implicating human leukocyte antigen (HLA) matching status between recipients and close-relative living donors.Therefore, we reviewed Korean GVHD cases following LDLT to identify LDLT-oriented characteristics of GVHD.This study included one case from each of three centers and three cases from one high-volume center.One-way donor-recipient HLA match was identified by HLA typing for donor and recipient.Of these six cases of LDLT diagnosed with GVHD, all patients died due to GVHD and its associated complications.In conclusion, post-LT GVHD is a fatal complication despite aggressive treatment approaches.Preventive measures, early diagnosis, early initiation of treatment protocols, prophylactic treatment, and appropriate palliative care are necessary to achieve success against GVHD.Further studies should be performed to reveal the mechanisms of GVHD and improve outcomes of patients who develop GVHD following LT.