Abstract
Background
: Graft-versus-host disease (GVHD) following liver transplantation (LT) is rare but can lead to significant mortality. The leading cause of death following GVHD diagnosis is infectious complications. However, there is a lack of clear descriptions concerning infection and antimicrobial management patterns. Our study aims to provide the focused details of all infectious complications of acute GVHD following LT.
Methods
: We retrospectively reviewed all adult LT recipients with acute GVHD at Mayo Clinic's Transplant Centers from January 1, 2010, to December 31, 2021. Detailed characteristics of infection in each case were described.
Results
: Among 4,585 LTs performed during this period, 12 (0.3%) patients developed acute GVHD. The median time from transplantation to GVHD diagnosis was 49.0 days [IQR 31.5-99.0]. Ten (83.3%) patients developed severe infections leading to mortality. The most common cause of infection was nosocomial bacteremia from enteric bacteria such as vancomycin-resistant enterococci and gram-negative bacilli. Other infections included breakthrough invasive fungal infections, cytomegalovirus (CMV) reactivation, and Clostridioides difficile colitis. Antimicrobial prophylaxis strategies in most cases were based on the degree of neutropenia – these include levofloxacin for bacterial prophylaxis, nebulized pentamidine for Pneumocystis jiroveci pneumonia prophylaxis, posaconazole for invasive fungal prophylaxis, and valganciclovir based on CMV status. All GVHD patients with severe infections succumbed to these complications.
Conclusions
: Our study reiterates that despite prophylaxis, infectious complications in GVHD following LT are common and lead to exceptionally high mortality. Individualized antimicrobial treatment, prophylaxis and monitoring strategies remain a critical component of GVHD management. Further study to optimize these practices is required.
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