Management of Graft versus Host Disease Involving the Bone Marrow: Interventions and Outcomes

Document Type

Conference Proceeding

Publication Date

8-2-2025

Publication Title

Am J Transplant

Abstract

Purpose: Cytopenias can significantly impact patient outcomes in the immediate post-solid organ transplant period, and they can result from acute graft-versus-host disease (GVHD), though this is less frequent. This study aims to detail our single-center experience with GVHD with bone marrow involvement in patients who underwent liver transplantation (LT) over 10 years. Methods: We reviewed medical charts for patients who underwent LTs at Henry Ford Hospital Transplant Center from January 2014 to December 2023. We recorded all confirmed cases of GVHD with bone marrow involvement after LT. We collected information on their demographics, details of the liver transplant, and how GVHD was presented, diagnosed, and treated. Results: Out of 1,045 LTs performed at our center, 17 patients (1.6%) developed GVHD after transplantation. Of them, 8 had bone marrow involvement that presented in all patients as pancytopenia. Most of them were male (75%) and white (50%). The mean age at presentation was 67 ± 5. The most common indication for transplant was metabolic dysregulation associated steatotic liver disease (MASLD) in 50% of patients. All patients received liver from deceased donor. The average time from transplantation to first symptom reported was 34 days (± 16.4 SD). 7 out of the 8 patients also had skin involvement that presented as a rash (87.5%). Gastrointestinal tract involvement was seen in 62.5% of them and presented as diarrhea in all cases. One patient also had involvement of their central nervous system, which presented as altered mental status and diagnosed with a lumbar puncture. At presentation, a short tandem repeat (STR) test on patients’ peripheral blood demonstrated the presence of a mean of 20.9% (± 31.1%) donor DNA. All patients received high-dose steroids as part of their treatment. 87.5% of them also received Etanercept as part of the treatment regimen, and half of them also received Photopheresis. Only one patient (12.5%) survived for more than 1 year after initial presentation, compared to 78% of patients with GVHD post LT who did not have bone marrow involvement. Conclusions: GVHD after solid organ transplantation typically presents with rash, diarrhea, fever, and pancytopenia 2 to 8 weeks after transplantation. Cytopenia has been described to confer a worse outcome. The lack of clinical trials for GVHD treatment limits an effective therapeutic strategy, and treatment outcomes of GVHD post liver transplant tend to be poor, with >85% mortality rate. [Formula presented] CITATION INFORMATION: Aburumman R., Tahmazian S., Nimri F., Jafri S. Management of Graft versus Host Disease Involving the Bone Marrow: Interventions and Outcomes AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: R. Aburumman: None.

Volume

25

Issue

8

First Page

S482

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