Abstract
RATIONALE: Acute graft-versus-host disease (GVHD) is a rare but highly fatal complication following liver transplantation (LT). This case report aims to summarize the diagnostic and therapeutic experiences to enhance clinical understanding. PATIENT CONCERNS: Two middle-aged male patients underwent LT for acute-on-chronic liver failure and hepatocellular carcinoma, respectively. Both subsequently developed nonspecific symptoms, including rash, fever, and signs of bone marrow suppression. DIAGNOSES: The diagnosis of GVHD was confirmed in both patients through skin biopsy and chimerism testing. INTERVENTIONS: The primary therapeutic approach involved high-dose corticosteroid therapy and intravenous immunoglobulin. OUTCOMES: Despite intervention, the outcomes for both patients were poor. Both patients succumbed to mortality, with causes of death being multiple organ failure and hemorrhagic shock, respectively. LESSONS: GVHD after LT carries a grave prognosis with poor treatment outcomes. This report underscores the critical importance of early diagnosis and intervention for managing this devastating complication.