Treatment of graft-versus-host disease after liver transplantation with basiliximab followed by bowel resection

Am J Transplant. 2003 Aug;3(8):1024-9. doi: 10.1034/j.1600-6143.2003.00108.x.

Abstract

Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a serious complication with mortality rates over 80%. Two patients with established GVHD after OLT were treated with Basiliximab, a chimeric murine human monoclonal antibody which binds to the alpha-chain of interleukin-2 receptor (IL-2R). Two males, aged 45 and 56 years, presented after OLT with a clinical picture consistent with GVHD. Quantitative measurements of recipient peripheral blood donor lymphocyte chimerism were carried out by flow cytometric analysis, and showed peak chimerism levels of 5% and 8%, respectively. Treatment comprised 3 doses of 1 g methyl prednisolone followed by 2 doses of 20 mg of Basiliximab. In both, treatment resulted in complete disappearance of macro-chimerism in blood. There was resolution of skin rash by day 7; however, diarrhea persisted. White cell scan showed increased uptake in the terminal ileum and small-bowel resection was performed in both patients. One patient is alive and well 36 months after OLT. The other patient had resolution of GVHD, but died of recurrent hepatitis C 1 year after OLT. The combination of immunological and surgical treatment for GVHD following solid organ transplantation has not previously been described.

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Basiliximab
  • Flow Cytometry
  • Graft vs Host Disease / drug therapy*
  • Graft vs Host Disease / genetics
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / surgery*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • In Situ Hybridization, Fluorescence
  • Intestine, Small / surgery*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Recombinant Fusion Proteins*

Substances

  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Basiliximab