Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation |
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Authors: | Shin Chu Ri Nathan Jaimie Alonso Maria Yazigi Nada Kocoshis Samuel Tiao Gregory Davies Stella M |
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Institution: | aDivision of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA;bDivision of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA;cDivision of Gastroenterology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA |
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Abstract: | PurposeGraft-versus-host disease (GVHD) after organ transplantation is a rare but life-threatening complication with very high mortality.MethodsA retrospective review was performed of all patients undergoing small bowel or combined organ transplantation at a single institution during 2003 to 2009. Patients with donor T-cell chimerism were analyzed in detail for development of GVHD.ResultsThirty-two patients were included in the study. Of 32 patients, 11 (34%) had donor T-cell chimerism (range, 0%-53%) studies performed; 7 (64%) of those 11 patients demonstrated clinical features of GVHD. All patients who demonstrated GVHD had detectable donor T-cell chimerism. All patients with GVHD presented with skin involvement. Graft-versus-host disease responded to increased immune suppression therapy. Mortality was 43% (3/7) among patients with GVHD and was caused by multiorgan failure and sepsis in all cases.ConclusionAcute and chronic GVHD were observed frequently after combined solid organ transplantation and were associated with significant mortality and morbidity. Alloreactive donor T cells cotransplanted with the organ likely play a role in the pathophysiology because levels of donor-derived T-cell chimerism correlated with the clinical course of GVHD. |
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Keywords: | Organ transplantation Graft-versus-host disease Donor T-cell chimerism |
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