Document Detail


Graft-versus-host disease after solid organ transplantation: a single center experience and review of literature.
MedLine Citation:
PMID:  23274334     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Graft-versus-host disease (GVHD) is an uncommon cause of morbidity and mortality after solid organ transplantation that is most likely under-diagnosed. We describe our single center experience with three cases of GVHD diagnosed over a period of 15 years in a total of 2,271 solid organ transplant recipients.
CASE REPORTS: We describe three case reports: (1) a 3-week old neonate who developed GVHD 16 months after living-related liver transplant, (2) a 14-year old adolescent who developed GVHD 4 months following an unrelated cadaveric pancreas transplant and; (3) a 27-year old male who developed GVHD 18 days after simultaneous kidney-pancreas transplant from an unrelated donor. GVHD was confirmed through skin biopsies, engraftment profile from bone marrow biopsy and variable number tandem repeat analysis. Treatment strategies included use of corticosteroids and sirolimus monotherapy, corticosteroids and mesenchymal stromal cell therapy and reduction of immunosuppression. We observed that African-American race, sexual and HLA mismatching and cytomegalovirus infection may be high risk factors for development of GVHD following solid organ transplant.
CONCLUSIONS: GVHD continues to be a rare but fatal complication following solid organ transplantation that demands a high index of clinical suspicion for diagnosis and management. Future approaches may focus on early recognition of risk factors and improving treatment protocols using a combination of mesenchymal stromal cell transplantation with pharmacotherapy.
Authors:
Amit Sharma; Amy E Armstrong; Marc P Posner; Pamela M Kimball; Adrian H Cotterell; Anne L King; Robert A Fisher; Kamar Godder
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Annals of transplantation : quarterly of the Polish Transplantation Society     Volume:  17     ISSN:  2329-0358     ISO Abbreviation:  Ann. Transplant.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-05-28     Revised Date:  2013-06-17    
Medline Journal Info:
Nlm Unique ID:  9802544     Medline TA:  Ann Transplant     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  133-9     Citation Subset:  IM    
Affiliation:
Department of Transplantation Surgery, Virginia Commonwealth University, Richmond, VA 23298, U.S.A. asharma@mcvh-vcu.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Fatal Outcome
Graft vs Host Disease / diagnosis*,  etiology
Graft vs Host Reaction
Humans
Infant, Newborn
Kidney Transplantation / immunology*
Liver Transplantation / immunology*
Male
Pancreas Transplantation / immunology*
Postoperative Complications / diagnosis*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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