Graft-vs-Host Disease Colitis After Lung Transplant

Kanthasamy, Kavin; Chang, Mimi Tan; Kaur, Manreet

doi:10.14309/crj.0000000000000287

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…Although rare after SOT, GVHD may still occur. Case series show administration of methylprednisolone for treatment of GVHD in some SOT patients; however, there are GC-treatment refractory patients, with high mortality rate of 82%[ 44 , 45 ].…”

Section: Transplant Recipientsmentioning

confidence: 99%

Current status of glucocorticoid usage in solid organ transplantation

Dashti‐Khavidaki¹,

Saidi²,

Lü³

2021

WJT

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Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering “transplantation” and “glucocorticoids”. GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

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Section: Transplant Recipientsmentioning

confidence: 99%

Current status of glucocorticoid usage in solid organ transplantation

Dashti‐Khavidaki¹,

Saidi²,

Lü³

2021

WJT

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Mycophenolate

2020

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How I diagnose and treat acute graft-versus-host disease after solid organ transplantation

Cooper

Abkowitz

2023

Blood

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Acute graft-versus-host disease (GVHD) is a rare complication following solid organ transplantation (SOT) carrying high mortality. Caused by immunocompetent donor leukocytes within the transplanted organ which become activated against recipient tissues, GVHD typically develops 2-12 weeks following SOT and can affect the skin, gastrointestinal tract, liver, and bone marrow. Signs and symptoms are nonspecific and include a rash, nausea, appetite loss, diarrhea, and cytopenias. Pancytopenia from marrow-directed GVHD is the primary driver of mortality. The diagnosis of GVHD is often delayed but should be confirmed by biopsy of an affected organ. Evidence of donor chimerism in blood or marrow supports the diagnosis. When GVHD is diagnosed we initiate treatment with systemic corticosteroids. At that time, if GVHD only involves skin or oral mucosa we also decrease maintenance immunosuppression levels to allow the recipient to reject the donor immune cells. For GVHD involving the marrow we initiate an allogeneic hematopoietic cell donor search early. In this article, we describe three cases of GVHD after SOT, outline our approach to diagnosis and management, and then provide analysis of the three instructive cases.

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Graft-vs-Host Disease Colitis After Lung Transplant

Cited by 3 publications

References 17 publications

Current status of glucocorticoid usage in solid organ transplantation

Current status of glucocorticoid usage in solid organ transplantation

Mycophenolate

How I diagnose and treat acute graft-versus-host disease after solid organ transplantation

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