Whole-liver intensity-modulated radiation therapy as a rescue therapy for acute graft-versus-host disease after liver transplantation

作者：Dong Chen, Yuanyuan Zhao, G. Hu, Bo Yang, Limin Zhang, Zipei Wang, Hui Guo, Qianyong Zhao, Lai Wei, Zhishui Chen · 发表于：Chinese Medical Journal · 年份：2024 · DOI：10.1097/cm9.0000000000003367 · 被引用次数：1 · 研究领域：Organ Transplantation Techniques and Outcomes、Hepatocellular Carcinoma Treatment and Prognosis、Hematopoietic Stem Cell Transplantation

To the Editor: Graft-versus-host disease (GVHD) is a rare but fatal complication after solid organ transplantation (SOT), with an incidence of 0.2–2.0%. Recent retrospective studies have shown a mortality rate of approximately 85–98% among patients with SOT-GVHD.[1] Various drugs and methods have been shown to improve or alleviate clinical symptoms, but no effective treatments for GVHD currently exist. Recent clinical experience with SOT-GVHD treatment is mixed and limited, including systemic or partial corticosteroid support, the use of Janus kinase (JAK) inhibitors, allogeneic hematopoietic cell transplantation (alloHCT), and donor-targeted serotherapy. Since the number of lymphocytes transplanted with the organ may be a risk factor for GVHD, reducing the number of donor lymphocytes seems beneficial. Intensity-modulated radiation therapy (IMRT) is a type of radiotherapy that uses optimized, non-uniform radiation beam intensities on the patient.[2] Local allograft irradiation has also been used to treat severe resistant rejection after liver transplantation (LT) in previous studies.[3] Based on this, we hypothesized that whole-liver IMRT at a low dosage could be used as a rescue therapy to control acute GVHD after LT by reducing the number of donor-derived immune cells. The donors in both cases were deceased, who donated after brain death (DBD). The study followed the guidelines of the Declaration of Helsinki. Written informed consent was obtained from both participants. The...