Intestinal derivation for digestive complications of graft versus host disease in adult patients: a case series and review of the literature

Abstract

Background: Graft Versus Host Disease (GvHD) is a frequent complication of hematopoietic stem cell transplantation (HSCT). Acute GvHD can involve intestinal tract which requires temporary fasting in addition to immunosuppressive treatment. Surgical management of gastrointestinal (GI) GVHD is an unusual approach.Objectives: Diversion stoma can help in healing the digestive tract during the acute phase of GI GvHD by keeping it free from any aggression. We report our experience of 6 adult patients with Gl GvHD who underwent intestinal surgery.Study Design: Medical files of patients who experienced biopsy-proven GI GvHD between 01/01/2011 and 31/12/2019 in Angers University hospital were retrospectively reviewed and patients who underwent GI surgery were analysed. Informed consent was obtained from all patients.Results: Between 2011 and 2019, 354 allogenic HSCT were performed and stage II to IV acute GI GvHD occurred in 42 patients. GI surgery and diversion stomas were required for 6 patients. Two surgeries were performed urgently for colonic perforation, 2 were performed for small bowel occlusion symptoms and 2 for uncontrolled GvHD symptoms despite medical treatment. All surgeries were performed safely. Diversion stomy could not prevent aGvHD progression and death in 2 patients. Additional treatment for GI GvHD was necessary in 1 patient while 3 patients did not receive any further treatment for GI GvHD after long-term follow-up. Two patients had successful bowel continuity restoration. Data from 29 patients who underwent GI surgery for acute GVH published so far are reviewed. Conclusion:GI surgical interventions are rarely required in patients with GI GvHD. There is a lack of data on digestive surgery in GI GVHD, including follow-up data and efficiency on GVHD-related symptoms. The use of digestive surgery as diversion stoma appeared feasible for severe GI GVHD and seems to benefit some patients. This data should be confirmed in a larger study.