LETHAL ACUTE GRAFT-VERSUS-HOST DISEASE IN A LIVER-TRANSPLANT RECIPIENT - RELATIONS WITH CELL-MIGRATION AND CHIMERISM

We report herein the case of a patient who developed fatal acute graft -versus host disease (GVHD) after liver transplantation (LT). GVHD occ urred 18 days after LT and was characterized by skin epidermolysis, di arrhea and leucopenia. Skin biopsy showed epidermal dyskeratosis with epithelial necrosis, a lesion consistent with GvHD. Despite immunosupp ressive therapy, the patient died within 24 days. In our observation, GVHD occurred although five HLA compatibilities were identified betwee n the donor and the recipient, an apparently favorable and uncommon si tuation. This case further supports the qualification that LT may be c omplicated by GvHD and strongly suggests that minor rather than major histocompatibility antigens are the main target of allogenic interacti ons of GVHD. The involvement of chimerism in GvHD is controversial and requires further investigation.