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.
|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|
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 June 2, 2020.
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