%0 Case Reports
%T When donor T cells attack: The curious case of liver transplant-associated acute graft-versus-host-disease.
%A Deschner M
%A Bastin DJ
%A Solh Z
%A Bosma K
%A Haddara W
%A Yang P
%A Broadbent R
%A Haig A
%A Keow J
%A Brahmania M
%A Xenocostas A
%A Deotare U
%J Sci Prog
%V 105
%N 3
%D Jul-Sep 2022
%M 35979627
%F 1.512
%R 10.1177/00368504221117070
%X Graft versus host disease is a rare but deadly complication of solid organ transplant. Clinical features of graft-versus-host-disease are non-specific, which may lead to delayed diagnosis as more common conditions including infections or drug reactions are considered. We describe a 54-year-old male patient who underwent liver transplantation for alcohol use disorder-related cirrhosis and developed acute graft-versus-host disease. Initial clinical presentation included dermatitis, bone marrow failure and enteritis. Results of skin biopsy and cytogenetic studies were consistent with liver transplant-associated acute graft-versus-host disease. The importance of this case is to highlight to transplant physicians and surgeons the challenges of diagnosing graft-versus-host-disease. In our case, pre-existing partnerships among the liver and hematopoietic stem cell transplant teams, transfusion medicine specialists, critical care specialists and facilitated timely communication relevant to confirming graft-versus-host disease. We propose an algorithm to assist in the workup of suspected graft-versus-host disease. Because this condition is characterized by high mortality, a high index of suspicion is imperative for prompt diagnosis and optimal management of the donor-recipient immune interaction when patients present with classic clinical features.