Solid organ graft-versus-host disease in a recipient of a COVID-19 positive liver graft

Area of Science:

• Transplantation Immunology
• Hepatology
• Infectious Diseases

Background:

• Solid organ transplant (SOT) graft-versus-host-disease (GVHD) is rare, with limited management guidelines.
• Hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) leading to end-stage liver disease (ESLD) necessitates transplantation.
• The role of Coronavirus disease 2019 (COVID-19) in SOT-GVHD is unexplored.

Purpose of the Study:

• To report a unique case of SOT-GVHD following liver transplantation from a COVID-19 positive donor.
• To discuss the diagnostic challenges and potential therapeutic strategies for SOT-GVHD.
• To raise awareness about the potential association between COVID-19 positive donors and SOT-GVHD.

Main Methods:

• A single-center case report of a 66-year-old male liver transplant recipient.
• Clinical presentation, laboratory findings, and diagnostic workup including bone marrow biopsy and chimerism analysis.
• Treatment with high-dose steroids and ruxolitinib for suspected SOT-GVHD and secondary hemophagocytic lymphohistiocytosis (HLH).

Main Results:

• The patient developed fever, diarrhea, pancytopenia, invasive aspergillosis, and rash post-transplant.
• Diagnosis of secondary HLH and SOT-GVHD was established.
• Treatment with ruxolitinib and steroids was initiated, but the patient's condition deteriorated, leading to transition to comfort care.

Conclusions:

• SOT-GVHD is a rare but serious complication following liver transplantation.
• The case suggests a potential, yet unconfirmed, role for COVID-19 in the development of SOT-GVHD.
• Further research is needed to understand the pathophysiology and establish management guidelines for SOT-GVHD, especially in the context of COVID-19.