Graft-vs-host disease after small bowel transplantation in children

详细信息    查看全文

• 作者：Ane M. Andres ; Manuel Lopez Santamarí ; a ; Esther Ramos ; Jesus Sarriá ; Manuel Molina ; Francisco Hern ; ez ; Jose L. Encinas ; Javier Larrauri ; Gerardo Prieto ; Juan Antonio Tovar
• 关键词：Small bowel transplantation ; Graft-vs-host disease
• 刊名：Journal of Pediatric Surgery
• 出版年：2010
• 出版时间：February 2010
• 年：2010
• 卷：45
• 期：2
• 页码：330-336
• 全文大小：543 K

文摘

Purpose

Graft-vs-host disease (GVHD) is a rare complication of transplantation of organs rich in immunocompetent cells. The goal of this study was to report the features of GVHD after small bowel transplantation (SBTx) in children.

Methods

The study involved a retrospective review of patients undergoing SBTx between 1999 and 2009 who had GVHD.

Results

Of 46 children receiving 52 intestinal grafts (2 liver-intestine and 3 multivisceral), 5 (10 % ) developed GVHD. Median age at transplant was 42 (19-204) months. Baseline immunosupression consisted of tacrolimus and steroids supplemented with thymoglobulin (n = 2) or basiliximab (n = 3) for induction. Median time between transplantation and GVHD was 47 (16-333) days. All patients had generalized rash, 2 had diarrhea, and 2 had respiratory symptoms. Other symptoms were glomerulonephritis (n = 1) and conjunctivitis (n = 1). Four developed severe hematologic disorders. The diagnosis was confirmed by skin biopsy in 4 patients and supported by chimerism studies in two. Colonoscopy and opthalmoscopic findings were also suggestive in one. Treatment consisted of steroids and decrease of tacrolimus, with partial response in four. Other immunosuppressants were used in refractory or recurrent cases. Three patients died within 4 months after diagnosis.

Conclusion

Graft-vs-host disease is a devastating complication of SBTx, with high mortality probably associated with severe immunologic dysregulation.