831 - Functional outcomes of Graft-versus-host disease following orthotopic liver transplantation

GVHD following an OLT is an uncommon but dangerous complication, with a mortality rate as high as 75%. GVHD occurs when graft T cells attack host tissue, leading to widespread damage. It typically manifests 3-5 weeks after transplant, most commonly with an erythematous, maculopapular rash. Fever, diarrhea, and pancytopenia are also common presenting symptoms. Treatment of GVHD typically includes high-dose steroids, frequently with the addition of immunosuppressants such as calcineurin inhibitors and IL-2 antagonists. While corticosteroids are a first-line treatment for GVHD, prolonged use may lead to steroid myopathy with an incidence as high as 50-60%. Additionally, many immunosuppressive agents used post-transplant can cause peripheral neuropathy, impairing balance and increasing fall risk for which referral to rehabilitation services may be indicated.

Conclusions: Although rare, GVHD after OLT can be life-threatening. This case highlights the importance of identifying signs of GVHD in OLT patients and considering the functional consequences of this diagnosis. Physiatrists who care for transplant recipients must be aware of the typical symptoms and timeline to monitor for this complication. A course of inpatient rehabilitation can provide these patients the opportunity to improve functional mobility before returning to the community.