*Purpose: Graft Versus Host Disease (GvHD) is a serious and potentially fatal disease that is rarely observed in solid organ transplant recipients; however, we report a case series of five liver transplant recipients who developed GvHD.

*Methods: Medical records of five liver transplant recipients were reviewed. The following information was collected: sex, age, date of transplant, cause of liver disease, use of induction at the time of transplant, time from transplant to diagnosis of GvHD, symptoms, immunosuppression regimen at the time of diagnosis, treatment, and outcome.

*Results: Of the five patients reviewed, the majority of the patients were male (n=4). The median time to GvHD onset was 36 days from transplant. Common GvHD manifestations included rash (n=5), fever (n=3), pancytopenia (n=2), mouth sores (n=2), and diarrhea (n=2). Typical treatment regimens for patients with GvHD included high dose methylprednisolone and anti-thymocyte globulin. Patients with refractory GvHD were also treated with basiliximab and infliximab. Three of the five patients recovered. The remaining two patients died from intracranial hemorrhage.

*Conclusions: The majority of patients who had developed GvHD at our center developed symptoms early in their post-transplant course. We found that high dose steroids, which are the mainstay treatment for GvHD, appeared to be ineffective in our patient population; however, the addition of anti-thymocyte globulin was effective in 60% (n=3) of the cases. This information will be utilized in the management of GvHD in liver transplant recipients at our institution in the future.

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