Etanercept for Graft Versus Host Disease Following Liver Transplantation

E. Ticehurst,¹ E. Blumberg,¹ F. Vyas,¹ K. Olthoff,¹ A. Shaked,¹ S. Bruno,¹ K. Butcavage,¹ E. Knight,¹ G. Smith,¹ S. Gill.²

¹Penn Transplant Institute, Phila, PA
²Hematology-Oncology, Dept of Medicine, Univ of Penn, Phila, PA.

Meeting: 2015 American Transplant Congress

Abstract number: C139

Keywords: Graft-versus-host-disease, Liver transplantation, Tumor necrosis factor (TNF)

Session Information

Session Name: Poster Session C: Liver Retransplantation and Other Complications

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Purpose: Graft versus host disease (GVHD) is a devastating diagnosis and treatment options, such as antithymocyte globulin (ATG), have poor response rates. With a goal of improving outcomes, we have used an etanercept-based (ETAN) treatment regimen in liver transplant (txp) patients. Our center's experience is described.

Methods: Single-center retrospective cohort

Results: GVHD was identified in 6 deceased donor liver txp patients over 4 years, each presenting within 3 months post-txp. In 2 cases, GVHD was preceded by herpesvirus infections (1 HHV6, 1 CMV). 2 patients were treated with ATG/methylprednisolone (MP) & 4 with ETAN/MP. All received antifungal prophylaxis/treatment. 4 of 6 patients expired due to sepsis; both who received ATG and 2 of 4 patients who received ETAN. Table 1 shows specific patient information.

Table 1
Age/Sex (Race)	ESLD	Clinical Features/# Days Post-Txp to GVHD	Rx	Time to Rx GVHD (days)	Chimerism:% donor cells, % CD3+ subset	Post-GVHD Infection	Outcome
64 F (W)	PBC	Pancytopenia, diarrhea, 35 days	ATG, MP	20	Pre-Rx: 7%, n/a; Post-Rx: 42%, n/a	VRE BSI, P aeruginosa LRTI	Expired
55 M (W)	HCV, ETOH	Pancytopenia, rash, diarrhea, 27 days	ATG, MP	12	Pre-Rx: 70%, 100%; Post-Rx: n/a	Mucormycosis, serratia BSI, VRE infected biloma	Expired
64 F (A)	HBV, HCC	Pancytopenia, fever, diarrhea, 13 days	ETAN, MP	9	Pre-Rx: 30%, 32%; Post-Rx: 98%, 91%	K pneumonia BSI x2, Polymicrobial BSI (K pneumonia, E cloacae, Enterococcus), Bacteremic K pneumonia LRTI x2, Fusarium BSI	Expired
61 M (W)	Cryptogenic	Rash, fever, diarrhea, 87 days	ETAN, MP	7	Pre-Rx: 4%, 72%; Post-Rx: 51%, 52%	Bacteremic K pneumonia pyelonephritis x2, polymicrobial BSI (S hemolyticus, B fragilis, Enterococcus), VRE, CMV	Expired after resolving GVHD
59 M (B)	HCV	Pancytopenia, fever, rash, diarrhea, 44 days	ETAN, MP	10	Pre-Rx: 12%, 93%; Post-Rx: 0%, inconclusive	VRE BSI, Bacteremic E coli pyelonephritis x2	Alive at 15 months post-Rx
59 M (B)	HCV, ETOH	Pancytopenia, rash, 60 days	ETAN, MP	1	Pre-Rx: 4%, 42%; Post-Rx: 0%, 1%		Alive at 2 months post-Rx

A=asian, B=black, W=white, BSI=blood stream infection, LRTI=lower respiratory tract infection

Conclusion: Two of four patients treated with etanercept survive to date. While small numbers limit our ability to make definitive conclusions, the outcome of patients treated with early etanercept appears superior to that of historical controls.

To cite this abstract in AMA style:

Ticehurst E, Blumberg E, Vyas F, Olthoff K, Shaked A, Bruno S, Butcavage K, Knight E, Smith G, Gill S. Etanercept for Graft Versus Host Disease Following Liver Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/etanercept-for-graft-versus-host-disease-following-liver-transplantation/. Accessed November 21, 2024.

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