Graft Versus Host Disease in Intestinal Transplantation

Abstract

Our aim was to analyze the clinical course and outcome of patients with graft vs. host disease (GVHD) after intestinal transplantation (ITx). All patients receiving ITx between May, 1990 and December, 2003 were retrospectively reviewed for evidence of GVHD. Two hundred and fifty patients underwent ITx during the study period. Graft vs. host disease was suspected clinically in 23 patients on the clinical basis of presentation such as skin rash, ulceration of oral mucosa, diarrhea, lymphadenopathy, or native liver dysfunction. Fourteen (eight children and six adults) patients (5.6% of total patient population) had GVHD confirmed by histopathological criteria including keratinocyte necrosis (n = = 9), epithelial apoptosis of the native gastrointestinal tract (n = = 4), and epithelial cell necrosis of oral mucosa (n = = 1). Donor-cell tissue infiltration or extensive peripheral blood donor-cell chimerism was documented on seven occasions. The majority of cases of GVHD resolved with steroid administration and optimization of tacrolimus immunosuppression.The incidence of histologically proven GVHD after clinical intestinal transplantation is 6.5% (8/122) in children and 4.7% (6/128) in adults. Successful clinical management requires a high index of suspicion to minimize morbidity and mortality. Diagnostic and treatment strategies based on this experience are proposed.

Autoimmune cytopaenia after paediatric intestinal transplantation: a case series

“…One last possibility we would like to emphasize is the production of alloantibodies by lymphocytes from the donor (graft-versus-host disease) as in patient 6. In this case, immunosuppression must be carefully managed [12]. This leads us to several hypotheses that have been discussed [13].…”

Graft-Versus-Host Disease After Simultaneous Pancreas–Kidney Transplantation: A Case Report and Review of the Literature

“…The incidence of GVHD after small bowel and liver transplantation is estimated at 5-10% and 1-2%, respectively (3,4). To date, 12 cases of GVHD following pancreas transplantation have been reported.…”

Current status of intestinal transplantation

“…This incidence is higher than that for other solid organ transplants. 18 The increased incidence may be due to the presence of substantial lymphatic tissue in the small intestine. It is important to identify and treat GVHD in its early stages, and to administer appropriate steroids and adjust tacrolimus levels as necessary.…”