Graft-Versus-Host Disease After Orthotopic Liver Transplantation: Multivariate Analysis of Risk Factors
Transplantation, Mayo Clinic, Jacksonville, FL
Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL.
Meeting: 2015 American Transplant Congress
Abstract number: A217
Keywords: Graft-versus-host-disease, HLA matching, Liver transplantation, Multivariate analysis
Session Information
Session Name: Poster Session A: Liver: Immunosuppression and Rejection
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Introduction:
Acute graft versus host disease (GVHD) is a rare fatal complication following orthotopic liver transplantation (OLT). It involves activation of donor T lymphocytes by antigen presenting cells in the OLT recipient, causing an alloreactive T-cell response to recipient tissues mediated by cytotoxic T cells and inflammatory cytokines. To date, several risk factors have been proposed, but these reports were inconclusive.
Aim and Method:
This is a retrospective single center case-control study of prospectively collected data from 2775 OLT performed at our institiution. Total of 8 cases (0.3%) of GVHD after OLT were diagnosed based on clinical characteristics coupled with skin and/or colonic biopsy. Each case was matched to three randomly selected controls based on the diagnosis of liver disease, recipient's age and blood group. Univariate and multivariate analysis were performed to identify the risk factors associated with occurence of GVHD after OLT.
Results:
Table (1) and (2) display the results of univariate and multivariate analysis comparing risk factors for GVHD. A recipient-donor age difference >20 years and any HLA class I match were the two main risk factors associated with the occurrence of GVHD in OLT recipients.
| Parameters | GVHD (n=8) | (n=24) | P Value |
| Recipient Age | 58.6 (6.6)* | 58.6 (6.6)* | 1.0 |
| Recipient Sex (Male) | 88% | 71% | 0.6 |
| Recipient Race (Caucasian) | 100% | 79% | 1.0 |
| Mean Age Difference in years (Recipient-Donor) | 29 (17.6)* | 10 (21)* | 0.03 |
| Donor younger than Recipient >20 years | 88% | 33% | 0.01 |
| Recipient-Donor Sex Mismatch | 25% | 38% | 0.7 |
| CMV Serology Mismatch (D+/R-) | 13% | 0% | 0.3 |
| Any HLA match | 63% | 58% | 1.0 |
| Any HLA Class I match | 63% | 25% | 0.09 |
| Any HLA class II match | 25% | 42% | 0.7 |
| Parameter | Relative Risk (95% Confidence Interval) | P Value |
| Age Difference (Recipient-Donor) | 1.06 (1.01-1.12) | 0.02 |
| Any HLA Class I Match | 9.76 (1.14-83.64) | 0.04 |
Conclusion:
Our study showed that the large age discrepancy between recipient and donor in addition to any HLA Class I match may increase the risk of GVHD in OLT recipients. Avoiding these two risk factors while selecting the prospective donors and recipients may reduce the further incidence of GVHD in the future. However, this study is limited in sample size and further studies are highly recommended to validate this findings.
To cite this abstract in AMA style:
Elfeki M, Genco P, Pungpapong S, Nguyen J, Harnois D. Graft-Versus-Host Disease After Orthotopic Liver Transplantation: Multivariate Analysis of Risk Factors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/graft-versus-host-disease-after-orthotopic-liver-transplantation-multivariate-analysis-of-risk-factors/. Accessed May 9, 2025.« Back to 2015 American Transplant Congress