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Søndergaard SH, Kamper-Jørgensen M. Pregnancy, cardiovascular health, and microchimerism. Curr Opin Lipidol 2024; 35:7-13. [PMID: 37982290 DOI: 10.1097/mol.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association. RECENT FINDINGS In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke. SUMMARY The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.
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Affiliation(s)
- Sara Hallum Søndergaard
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen K, Denmark
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2
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Oza K, Kang J, Patil D, Owen KL, Cui W, Khan K, Kaufman SS, Kroemer A. Current Advances in Graft-versus-host Disease After Intestinal Transplantation. Transplantation 2024; 108:399-408. [PMID: 37309025 DOI: 10.1097/tp.0000000000004703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Graft-versus-host disease (GvHD) remains a potentially fatal complication following intestinal transplant (ITx). Over the past decade, advances in the understanding of the pathophysiology of this complex immunological phenomenon have led to the reassessment of the host systemic immune response and have created a gateway for novel preventive and therapeutic strategies. Although sufficient evidence dictates the use of corticosteroids as a first-line option, the treatment for refractory disease remains contentious and lacks a standardized therapeutic approach. Timely diagnosis remains crucial, and the advent of chimerism detection and immunological biomarkers have transformed the identification, prognostication, and potential for survival after GvHD in ITx. The objectives of the following review aim to discuss the clinical and diagnostic features, pathophysiology, advances in immune biomarkers, as well as therapeutic opportunities in the prevention and treatment of GvHD in ITx.
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Affiliation(s)
- Kesha Oza
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jiman Kang
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC
| | - Digvijay Patil
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
| | - Kathryn L Owen
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
| | - Wanxing Cui
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC
| | - Khalid Khan
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
| | - Stuart S Kaufman
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
| | - Alexander Kroemer
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, DC
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3
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Male-origin microchimerism and endometrial cancer: A prospective case-cohort study. Cancer Epidemiol 2022; 79:102169. [DOI: 10.1016/j.canep.2022.102169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
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4
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Sedov E, McCarthy J, Koren E, Fuchs Y. Fetomaternal microchimerism in tissue repair and tumor development. Dev Cell 2022; 57:1442-1452. [PMID: 35700729 DOI: 10.1016/j.devcel.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
Abstract
In various placental mammals, the bidirectional exchange of cells during pregnancy can lead to the acquisition of genetically unique cells that can persist in both mother and child for decades. Over the years, it has become increasingly clear that this phenomenon, termed fetomaternal microchimerism may play key roles in a number of biological processes. In this perspective, we explore the concept of fetomaternal microchimerism and outline how fetal microchimeric cells are detected and immunologically tolerated within the maternal setting. Moreover, we discuss undertakings in the field that hint at the significant plasticity of fetal microchimeric cells and their potential roles in promoting maternal wound healing. Finally, we explore the multifaceted roles of fetal microchimeric cells in cancer development and progression. A deeper understanding of fetomaternal chimerism in healthy and diseased states will be key toward developing more efficient anti-cancer treatments and regenerative therapies.
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Affiliation(s)
- Egor Sedov
- Laboratory of Stem Cell Biology and Regenerative Medicine, Department of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Israel; Lorry Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion Israel Institute of Technology, Haifa 3200003, Israel; Technion Integrated Cancer Center, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Jordan McCarthy
- Laboratory of Stem Cell Biology and Regenerative Medicine, Department of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Israel; Lorry Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion Israel Institute of Technology, Haifa 3200003, Israel; Technion Integrated Cancer Center, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Elle Koren
- Laboratory of Stem Cell Biology and Regenerative Medicine, Department of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Israel; Lorry Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion Israel Institute of Technology, Haifa 3200003, Israel; Technion Integrated Cancer Center, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Yaron Fuchs
- Laboratory of Stem Cell Biology and Regenerative Medicine, Department of Biology, Technion - Israel Institute of Technology, Haifa 3200003, Israel; Lorry Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion Israel Institute of Technology, Haifa 3200003, Israel; Technion Integrated Cancer Center, Technion Israel Institute of Technology, Haifa 3200003, Israel.
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5
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Attas RAA, Bader RM, Mashhour M, AlQahtani ZA, Mohammed A, Qahtani M, Arain ZB, Faraidy N, Awaji M, Mohammed G, Alharbi HA, AlZahrani M, Aqool A, Salim G. Graft-versus-host disease after pediatric liver transplantation: A diagnostic challenge. Pediatr Transplant 2022; 26:e14205. [PMID: 34931754 DOI: 10.1111/petr.14205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a rare but serious complication after pediatric liver transplantation (LTx). Early diagnosis is difficult due to nonspecific presenting symptoms and non-pathognomonic skin histopathological features. The aim of this article was to describe a case of pediatric GVHD after LTx and to review available data on pediatric GVHD highlighting the diagnostic difficulty. We also propose a diagnostic algorithm to improve the diagnostic capability and increase clinical awareness about this potentially fatal condition. METHODS We did a comprehensive literatures review on studies on GvHD following pediatric LTx between 1990 and February 2021, chimerism study by short tandem repeat (STR), HLA typing by sequence-specific oligonucleotide (SSO) method, and flowcytometry crossmatch. RESULTS Our search yielded 23 case reports. The most common clinical manifestations were fever and rash (91%) followed by diarrhea. Mortality rate was 36.8% mainly due to sepsis and organ failure. Diagnosis was challenging and chimerism study to confirm donor engraftment was performed on only half of the cases. Prevalence of "donor dominant HLA one-way matching" typically occurs in homozygous parents-to-child transplantation was 75% in cases with HLA testing. CONCLUSION So far, there are no available standard diagnostic criteria for GVHD following pediatric LTx. Recognition of multiple risk factors through proper laboratory assessment can predict the occurrence, and early chimerism study can confirm suggestive clinical manifestation. The strong likelihood of developing GVHD in "donor one-way HLA match" and the severe problems imposed by this complication may justify avoidance of HLA homozygous parent's donation.
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Affiliation(s)
- Rabab Ali Al Attas
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia.,Saudi Society of Bone Marrow Transplantation (SSBM), Riyadh, Saudi Arabia
| | - Razan M Bader
- Pediatric Liver Transplant, Liver Transplant Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Miral Mashhour
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Zuhoor A AlQahtani
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Amani Mohammed
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Masood Qahtani
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Zahid B Arain
- Liver Transplant, Liver Transplant Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Nadya Faraidy
- Dermatology, Medicine Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Mohammad Awaji
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Gamil Mohammed
- Dermatology, Medicine Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Hassan A Alharbi
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Mariam AlZahrani
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Amal Aqool
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
| | - Ghandorah Salim
- Histocompatibility and Immunogenetic Lab, Department of pathology and Laboratory Medicine, King Fahad Specialist Hospital- Dammam, Dammam, Saudi Arabia
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6
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Sato N, Marubashi S. How is transfusion-associated graft-versus-host disease similar to, yet different from, organ transplantation-associated graft-versus-host disease? Transfus Apher Sci 2022; 61:103406. [DOI: 10.1016/j.transci.2022.103406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Lewis D, Glehn-Ponsirenas R, Gulbahce N, Hooey LJ, Chaffin JM, Miles J, Woodward R, Duarte S, Beduschi T, Zarrinpar A. High levels of donor-derived cell-free DNA in a case of graft-versus-host-disease following liver transplantation. Am J Transplant 2022; 22:973-976. [PMID: 34825479 DOI: 10.1111/ajt.16894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/17/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023]
Abstract
The diagnosis of graft-versus-host-disease (GVHD) after solid organ transplantation is made difficult by its variable clinical presentation and lack of sensitive and specific biomarkers to evaluate the immune state of transplant recipients. Emerging noninvasive diagnostic techniques like the quantification of donor-derived cell-free DNA (dd-cfDNA) for surveillance may improve the current standard-of-care. Herein, we report the use of this methodology in a patient with GVHD and corresponding levels of dd-cfDNA without any evidence of graft injury. Correlation of dd-cfDNA levels with the clinical course and its novel application here could lead to improvements in the rapid diagnosis of GVHD and in monitoring of response to treatment.
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Affiliation(s)
- Duncan Lewis
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | | | - Natali Gulbahce
- Research & Development Department, CareDx, Inc., Brisbane, California
| | - Leah J Hooey
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, Florida
| | - Joanna M Chaffin
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Jake Miles
- Medical Affairs Department, CareDx, Inc., Brisbane, California
| | - Robert Woodward
- Research & Development Department, CareDx, Inc., Brisbane, California
| | - Sergio Duarte
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Thiago Beduschi
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Ali Zarrinpar
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
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8
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Rodriguez JV, Tormey CA. Can transfusion-associated graft-versus-host disease (TA-GvHD) be prevented with leukoreduction alone? Transfus Apher Sci 2022; 61:103402. [DOI: 10.1016/j.transci.2022.103402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Newell LF, Dunlap J, Gatter K, Bagby GC, Press RD, Cook RJ, Fletcher L, Leonard JT, Leong KM, Bubalo JS, Olyaei A, Deloughery TG, Maziarz RT, Maynard E, Orloff SL, Enestvedt CK. Graft-versus-host disease after liver transplantation is associated with bone marrow failure, hemophagocytosis, and DNMT3A mutations. Am J Transplant 2021; 21:3894-3906. [PMID: 33961341 DOI: 10.1111/ajt.16635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 01/25/2023]
Abstract
Graft-versus-host disease after liver transplantation (LT-GVHD) is rare, frequently fatal, and associated with bone marrow failure (BMF), cytopenias, and hyperferritinemia. Given hyperferritinemia and cytopenias are present in hemophagocytic lymphohistiocytosis (HLH), and somatic mutations in hematopoietic cells are associated with hyperinflammatory responses (clonal hematopoiesis of indeterminate potential, CHIP), we identified the frequency of hemophagocytosis and CHIP mutations in LT-GVHD. We reviewed bone marrow aspirates and biopsies, quantified blood/marrow chimerism, and performed next-generation sequencing (NGS) with a targeted panel of genes relevant to myeloid malignancies, CHIP, and BMF. In all, 12 marrows were reviewed from 9 LT-GVHD patients. In all, 10 aspirates were evaluable for hemophagocytosis; 7 had adequate DNA for NGS. NGS was also performed on marrow from an LT cohort (n = 6) without GVHD. Nine of 10 aspirates in LT-GVHD patients showed increased hemophagocytosis. Five (71%) of 7 with LT-GVHD had DNMT3A mutations; only 1 of 6 in the non-GVHD LT cohort demonstrated DNMT3A mutation (p = .04). Only 1 LT-GVHD patient survived. BMF with HLH features was associated with poor hematopoietic recovery, and DNMT3A mutations were over-represented, in LT-GVHD patients. Identification of HLH features may guide prognosis and therapeutics. Further studies are needed to clarify the origin and impact of CHIP mutations on the hyperinflammatory state.
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Affiliation(s)
- Laura F Newell
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ken Gatter
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Grover C Bagby
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard D Press
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel J Cook
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Luke Fletcher
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jessica T Leonard
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelli M Leong
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph S Bubalo
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Ali Olyaei
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas G Deloughery
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard T Maziarz
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Maynard
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan L Orloff
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
| | - C Kristian Enestvedt
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
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10
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Tian M, Lyu Y, Wang B, Liu C, Yu L, Shi JH, Liu XM, Zhang XG, Guo K, Li Y, Hu LS. Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases. World J Clin Cases 2021; 9:9255-9268. [PMID: 34786412 PMCID: PMC8567504 DOI: 10.12998/wjcc.v9.i30.9255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) following liver transplantation (LT) is an unpredictable complication with poor outcome. However, consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking. The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD (aGVHD) following LT and reviewed the pertinent literature.
CASE SUMMARY Between January 1st, 2000 and December 31st, 2020, a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University. Six recipients developed aGVHD with clinical symptoms of fever, rash, diarrhea, and pancytopenia. The incidence of aGVHD was 0.57%. The median time from LT to the clinical presentation of aGVHD was 22.17 d. The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d. All six cases underwent treatment of immunosuppressant adjustment, corticosteroids, human normal immunoglobulin, and antithymocyte globulin/IL-2 antagonists. Despite intensive treatment strategies, 4 patients were deceased due to sepsis, multiple organ failure, and cerebral hemorrhage. The remaining two cases were discharged as treatment successfully. However, one died because of tuberculosis infection on the 6th month of follow-up, the other one was alive healthy during 30 mo of follow-up.
CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom, histopathological features, and the donor T-lymphocyte chimerism. Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD. Moreover, gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.
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Affiliation(s)
- Min Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Bo Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Liang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Jian-Hua Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xiao-Gang Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Kun Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Liang-Shuo Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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11
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Xiao JJ, Ma JY, Liao J, Wu D, Lv C, Li HY, Zuo S, Zhu HT, Gu HJ. Fluorescence in situ hybridization-based confirmation of acute graft- vs-host disease diagnosis following liver transplantation: A case report. World J Gastrointest Surg 2021; 13:1102-1109. [PMID: 34621484 PMCID: PMC8462082 DOI: 10.4240/wjgs.v13.i9.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/13/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although acute graft-vs-host disease (aGvHD) is a rare complication of liver transplantation, it is poorly understood and has an extremely high mortality rate. No standardized diagnostic criteria or treatment regimens currently exist.
CASE SUMMARY The present study investigated the etiology, diagnosis, and treatment of aGvHD following liver transplantation. Presentation, diagnosis, disease course, histology, and treatment of an aGvHD case are reported, and associated literature is reviewed. A 64-year-old female required LTx due to primary biliary cirrhosis. The donor was a 12-year-old male. Three weeks following liver transplantation, the recipient developed pyrexia, diarrhea, rashes, and antibiotic-unresponsive pancytopenia. Clinical symptoms together with laboratory investigations suggested a diagnosis of aGvHD, which was confirmed via peripheral blood fluorescent in situ hybridization. Donor XY chromosome fluorescent in situ hybridization indicating early chimerism achieved 93% sensitivity in the detection of GvHD. Existing immunosuppressants were discontinued, and high-dose intravenous methylprednisolone was initiated along with antibiotics. While diarrhea resolved, the patient’s general condition continued to deteriorate until demise due to multi-system organ failure at 37 d post-liver transplantation. This case illustrates the life-threatening nature of aGvHD.
CONCLUSION Herein, we have summarized a post-LTx aGvHD case and reviewed associated literature in order to increase awareness and provide potentially risk-mitigating recommendations.
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Affiliation(s)
- Jing-Jing Xiao
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Jin-Yu Ma
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Jun Liao
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Di Wu
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Chao Lv
- School of Clinical Medicine, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Hai-Yang Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Shi Zuo
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Hai-Tao Zhu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Hua-Jian Gu
- Department of Pediatric Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
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12
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Tang GT, Shaylor R, Hui V, Przybylowski G, Jones RM, Starkey G, Perini MV, Wang BZ, Zantomio D, Hogan C, Fink MA. The use of organ donor blood in liver transplantation. Clin Transplant 2021; 35:e14419. [PMID: 34236114 DOI: 10.1111/ctr.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood removed from organs during deceased donor organ procurement is routinely discarded but is a potential resource for donor-specific transfusion (DST) in subsequent liver transplantation (LT). This study retrospectively analyses the impact of DST on intraoperative bank blood product usage, long-term graft and patient survival, as well as frequency of rejection post-LT. METHODS A total of 992 adult LT performed from 1993 to 2018 in a single quaternary centre were included. Intraoperative blood product usage, patient and graft survival, as well as acute and chronic rejection were assessed in patients who received blood retrieved from the organ donor, the 'donor blood' (DB) group (n = 437) and patients who did not, the 'no donor blood' (NDB) group (n = 555). RESULTS Processing of DB ensured safe levels of potassium, magnesium and insulin. There were fewer units of bank red blood cells transfusion required in the DB group compared to NDB group (2 vs 4 units, P = 0.01). Graft survival was significantly superior in the DB group (10-year survival 75% vs 69%, respectively, P = 0.04) but DST was not an independent predictor of graft survival. There was no significant difference in patient survival or rejection between the groups. There was no difference in treated, biopsy-proven rejection between the two groups. CONCLUSIONS This is the first large-cohort study assessing long-term outcomes of intraoperative DST in LT. The collection of organ donor blood and subsequent use in LT recipients appeared feasible with appropriate quality checks ensuring safety. DST resulted in a reduction in the use of packed red blood cells. There was no difference in the rate of rejection or graft or patient survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gia Toan Tang
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Ruth Shaylor
- Department of Anaesthesia, Austin Health, Melbourne, 3084, Australia
| | - Victor Hui
- Department of Anaesthesia, Austin Health, Melbourne, 3084, Australia
| | - Greg Przybylowski
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Robert McLaren Jones
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Marcos Vinicius Perini
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Bao-Zhong Wang
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Daniela Zantomio
- Department of Haematology, Austin Health, Melbourne, 3084, Australia
| | - Chris Hogan
- Department of Haematology, Austin Health, Melbourne, 3084, Australia
| | - Michael Anthony Fink
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
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13
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Wang L, Yang B, Wei L, Chen D, Zhao Y, Chen Z. Acute graft-versus-host disease after liver transplantation in a close contact with COVID-19: A case report. Transpl Immunol 2021; 68:101435. [PMID: 34216759 PMCID: PMC8245304 DOI: 10.1016/j.trim.2021.101435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Acute graft-versus-host disease (aGVHD) is a rare complication after liver transplantation that characterized by high mortality. We presented a case of aGVHD after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). The patient suffered from fever, oral ulcer, rashes and diarrhea and had a co-infection with Cytomegalovirus (CMV). Short tandem repeat (STR) analysis for cluster of differentiation (CD3) cells and skin biopsy indicated aGVHD. His regimens included high dose of steroids, ruxolitinib, basiliximab, local liver radiotherapy and antibiotics prophylaxis, with the withdrawal of tacrolimus and MMF. Unfortunately, he developed an acute rejection followed by cytomegalovirus infection and lung infection. Soon afterwards he was sent to “isolation ward” due to high suspicion for clinical coronavirus disease 2019 (COVID-19). Fortunately, He was excluded from COVID-19 after nucleic acid and antibody tests. Though closely contact with other COVID-19 patients for a month, the patient was not affected with COVID-19 through his careful protective measures. Finally, the patient recovered after antiviral and antifungal treatment. To our knowledge, this is the first case report of a patient recovered from aGVHD as a close contact.
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Affiliation(s)
- Lu Wang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
| | - Lai Wei
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
| | - Dong Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Yuanyuan Zhao
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China
| | - Zhishui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, Wuhan 430030, China.
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14
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López-Valle A, García-Reyne A, Loinaz-Segurola C, Sanchez-Pina J, Rodríguez-Peralto JL, Zarco-Olivo C. Toxic epidermal necrolysis-like graft vs host disease following orthotopic liver transplantation: a case with skin chimerism. J Eur Acad Dermatol Venereol 2021; 35:e663-e665. [PMID: 34014572 DOI: 10.1111/jdv.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A López-Valle
- Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
| | - A García-Reyne
- Department of Internal Medicine, Hospital 12 de Octubre, Madrid, Spain
| | - C Loinaz-Segurola
- Department of General and Gastrointestinal Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - J Sanchez-Pina
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | | | - C Zarco-Olivo
- Department of Internal Medicine, Hospital 12 de Octubre, Madrid, Spain
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15
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Singh P, Razonable RR, Lorenz EC, DiCaudo DJ, Sukov WR, Bridges AG, Alkhateeb HB, Hogan WJ, Nattawat K, Thirunavukkarasu S, Amer H, Kudva YC, Khamash H, Stegall M, Kukla A. Chronic graft-versus-host disease in pancreas after kidney transplant recipients - An unrecognized entity. Am J Transplant 2021; 21:883-888. [PMID: 32805087 PMCID: PMC7870559 DOI: 10.1111/ajt.16273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 01/25/2023]
Abstract
Graft-versus-host disease (GVHD), a common complication after peripheral blood stem cell or bone marrow transplantation, rarely occurs in kidney and pancreas transplant recipients. The true incidence may be confounded by the rarity of the disorder, with a resultant lack of appreciation of the diagnosis as a potential cause of common clinical manifestations such as cytopenias and immune dysfunction. Reports of GVHD in kidney and pancreas transplant recipients almost uniformly describe patients in the early posttransplant period (days to months) with the typical manifestations of acute GVHD involving the skin, liver, and intestines. In contrast, reports of solid organ transplant recipients with clinical features more consistent with chronic GVHD (cGVHD) are lacking, raising concern of underrecognition of this severe complication. Occurrence later after transplant may be even more likely to result in lack of recognition. We report 2 cases of possible cGVHD occurring in recipients of pancreas after kidney transplantation, which were diagnosed at 5.5 and 42 months after pancreas transplant. Both patients presented with severe pancytopenia, multiple opportunistic infections, and features suggestive of cGVHD. Transplant professionals should be aware of the possibility of acute and cGVHD in pancreas after kidney transplant recipients and be able to recognize the clinical manifestations.
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Affiliation(s)
- Prince Singh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R. Razonable
- Division of Infectious Diseases, Mayo Clinic, Rochester, Rochester, Minnesota, USA
| | - Elizabeth C. Lorenz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - David J. DiCaudo
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - William R. Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alina G. Bridges
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Klomjit Nattawat
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic Rochester, Minnesota, USA
| | - Hassan Khamash
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mark Stegall
- Von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota, USA,Departments of Surgery and Immunology, Division of Transplant Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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16
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El-Ansary M, Saadi G, Hassaballa M, Zidan M, Abdel Fattah W, Kelany AK, Hanna MOF. Donor cell microchimerism in kidney transplantation: Implications for graft function. Int J Immunogenet 2020; 47:494-500. [PMID: 32881306 DOI: 10.1111/iji.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 11/28/2022]
Abstract
Given the uncertainty regarding the relationship between donor cells at microchimeric levels and its influence on graft function and clinical outcome, we explored the extent and importance of donor microchimerism in kidney transplantation. Twenty patients with chronic kidney disease who had received allografts from living donors were studied. We examined peripheral whole blood samples from the recipients one month after the transplant, applying mitochondrial DNA variant-specific polymerase chain reaction (PCR) to identify and quantify donor cells in relation to allograft function and survival during three years of follow-up. Higher quantities of donor-derived cell microchimerism in the peripheral blood correlated with better graft function in the early postoperative period at 1 month (R2 = .536, p = .001) and predicted improved graft function 1 year following the transplant (R2 = .430, p = .008). Furthermore, early post-transplant quantities of donor cell microchimerism were an important predictor of improved kidney function 3 years after transplantation (R2 = .397, p = .021). However, donor cell microchimerism failed to predict patient and graft survival after 3 years (odds ratio = 0.536, p = .860). Our findings suggest that donor cell microchimerism plays an immunoregulatory role in kidney transplantation and contributes to donor-specific immune hypo-responsiveness and graft acceptance.
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Affiliation(s)
- Mervat El-Ansary
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Saadi
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - May Hassaballa
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Zidan
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Walaa Abdel Fattah
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayda K Kelany
- Genome Unit, Kasr El-Aini, Cairo University, Cairo, Egypt
| | - Mariam Onsy F Hanna
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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17
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Zhang G, Qin W, Yuan J, Ming C, Yue S, Liu Z, Yu L, Yu M, Gao X, Zhou Y, Wang L, Yang X, Dou K, Wang H. A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review. Front Med (Lausanne) 2020; 7:148. [PMID: 32411713 PMCID: PMC7198728 DOI: 10.3389/fmed.2020.00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/06/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the long-term effect of triple organ transplantation (liver, kidney, and pancreas) in a patient with end-stage liver disease, post chronic hepatitis B, cirrhosis, chronic renal failure, and insulin-dependent diabetes mellitus caused by chronic pancreatitis and to explore the optimal surgical procedure. Case: A 43-year-old man with progressive emaciation and hypourocrinia for 2 months. Results indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure. Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed in 2005. Pancreatic exocrine secretions were drained enterically to the jejunum, and the donor kidney was placed in the left iliac fossa. Patient was prescribed with prednisone, tacrolimus, mycophenolate mofetil, Rabbit Anti-human Thymocyte Immunoglobulin, and simulect for immunosuppression. Results: Satisfactory hepatic and pancreatic functional recovery was achieved within 7 days post-surgery. The kidney was not functional, and continuous renal replacement therapy was used. However, the donor kidney was removed at day 16 post-surgery due to acute rejection reaction. A new renal transplantation at the same position was performed, and satisfactory kidney function from the new graft was achieved 3 days later. In 14 years of follow-up, patient has not had any rejection reactions or other complications such as pancreatitis, thrombosis, and localized infections. The patient is insulin independent with normal liver and renal functions. FK506+Pred was used for immunosuppression, and the tac tough level maintained 3.0–4.5 ng/ml. Lamivudine was prescribed for long-term use to inhibit HBV virus duplication. Conclusion: Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.
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Affiliation(s)
- Geng Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Changsheng Ming
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuqiang Yue
- Department of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhengcai Liu
- Department of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Yu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming Yu
- Department of Ultrasound Diagnostics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaokang Gao
- Department of Urology, General Hospital of Xinjiang Military Region, Urumqi, China
| | - Yu Zhou
- Department of Urology, Central Theater Command General Hospital of The Chinese People's Liberation Army, Wuhan, China
| | - Longxin Wang
- Urology Department, Maanshan People's Hospital, Maanshan, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kefeng Dou
- Department of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - He Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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18
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Wood A, Eghtesad B, Lindenmeyer CC. Graft-Versus-Host Disease After Liver Transplantation. Clin Liver Dis (Hoboken) 2020; 15:81-84. [PMID: 32226622 PMCID: PMC7098667 DOI: 10.1002/cld.884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023] Open
Abstract
http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-reading-wood a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-interview-lindenmeyer an interview with the author.
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Affiliation(s)
- Ashley Wood
- Department of Internal MedicineCleveland ClinicClevelandOH
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
| | - Christina C. Lindenmeyer
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
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19
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Kim KJ, Lee TB, Yang KH, Ryu JH, Choi BH, Lee HJ, Lee SM, Kim IS. Temporary Cessation of Immunosuppression for Infection May Contribute to the Development of Graft-vs-Host Disease After ABO-Incompatible Living Donor Liver Transplantation: A Case Report. Transplant Proc 2019; 51:3136-3139. [PMID: 31611115 DOI: 10.1016/j.transproceed.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 11/27/2022]
Abstract
Graft-vs-host disease (GVHD) after liver transplantation is a rare complication with a high mortality rate. A complex interplay between donor and recipient immunity plays a role in the development of GVHD. Infection following liver transplantation is one of the most common complications in a recipient of an organ transplant who is immunosuppressed. On clinical signs of infection, the immune reaction of the recipient can be reconstituted by withdrawal of immunosuppression in order to help combat infection. However, the discontinuation of immunosuppression could restore the donor's immune activity rather than that of the recipient. There is little information available as to whether the discontinuation of immunosuppression for severe infection could contribute to the development of GVHD in a patient who underwent ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). Herein, we present a unique case of GVHD following ABO-I LDLT, for which the cessation of immunosuppression could be responsible.
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Affiliation(s)
- Keun Ju Kim
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Beom Lee
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kwang Ho Yang
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Je Ho Ryu
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung Hyun Choi
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun-Ji Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - Sun-Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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20
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Stanley K, Ranganathan S, Mazariegos G, Bond G, Soltys K, Ganoza A, Jones K, Cieply K, Sindhi R. Donor mucosal immunocytes perpetuate refractory GVHD after intestinal transplantation without engrafting in recipient bone marrow: Case report and review of the literature. Pediatr Transplant 2019; 23:e13350. [PMID: 30672115 DOI: 10.1111/petr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/31/2018] [Accepted: 12/16/2018] [Indexed: 11/30/2022]
Abstract
GVHD as a complication of SOT presents both a diagnostic and therapeutic challenge. Typically affecting the skin, gastrointestinal tract, and liver, GVHD occurs when donor lymphocytes engrafted in recipient tissues are activated by host antigen-presenting cells resulting in cytokine release and donor cell-mediated cytotoxicity to host tissue. Here, we describe a 5-year-old girl who developed fatal, refractory GVHD after isolated intestinal transplantation when recipient immune cells failed to repopulate the allograft in the setting of CMV viremia. Persistence of the donor immune cells in the allograft mucosa, rather than engraftment in the recipient bone marrow, likely perpetuated this refractory GVHD. Early diagnosis and intervention are critical to reduce morbidity and mortality. Thus, periodic monitoring of peripheral blood and allograft mucosal chimerism with sensitive detection methods may allow early detection and potentially curative enterectomy in similar cases of refractory GVHD.
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Affiliation(s)
- Kaitlin Stanley
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - George Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Geoffrey Bond
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Armando Ganoza
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katie Jones
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen Cieply
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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21
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Chen W, Ma T, Bai X, Zhang X, Li G, Lao M, Liang T. Acute Graft-vs-Host Disease After Liver Transplantation in a Patient Presenting With Neurogenic Symptoms as the Single Primary Manifestation: A Case Report. Transplant Proc 2018; 50:4028-4032. [DOI: 10.1016/j.transproceed.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/23/2018] [Indexed: 12/24/2022]
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22
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Bahar B, Tormey CA. Prevention of Transfusion-Associated Graft-Versus-Host Disease With Blood Product Irradiation: The Past, Present, and Future. Arch Pathol Lab Med 2018; 142:662-667. [DOI: 10.5858/arpa.2016-0620-rs] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Transfusion-associated graft-versus-host disease (TA-GVHD) is a disease with a very high mortality rate. In this report, we discuss TA-GVHD from a historical perspective, highlight the pathogenesis of TA-GVHD, and emphasize the importance of blood product irradiation, which is a very effective means to prevent this disease. We summarize the current recommendations in different patient populations from different countries and review recent developments, such as alternatives for the use of radioactive materials. We also speculate on future directions.
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Affiliation(s)
| | - Christopher A. Tormey
- From the Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut (Drs Bahar and Tormey); and the Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut (Dr Tormey)
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23
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24
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Vásquez-Montoya GA, Danobeitia JS, Fernández LA, Hernández-Ortiz JP. Computational immuno-biology for organ transplantation and regenerative medicine. Transplant Rev (Orlando) 2016; 30:235-46. [PMID: 27296889 DOI: 10.1016/j.trre.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/20/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
Organ transplantation and regenerative medicine are adopted platforms that provide replacement tissues and organs from natural or engineered sources. Acceptance, tolerance and rejection depend greatly on the proper control of the immune response against graft antigens, motivating the development of immunological and genetical therapies that prevent organ failure. They rely on a complete, or partial, understanding of the immune system. Ultimately, they are innovative technologies that ensure permanent graft tolerance and indefinite graft survival through the modulation of the immune system. Computational immunology has arisen as a tool towards a mechanistic understanding of the biological and physicochemical processes surrounding an immune response. It comprehends theoretical and computational frameworks that simulate immuno-biological systems. The challenge is centered on the multi-scale character of the immune system that spans from atomistic scales, during peptide-epitope and protein interactions, to macroscopic scales, for lymph transport and organ-organ reactions. In this paper, we discuss, from an engineering perspective, the biological processes that are involved during the immune response of organ transplantation. Previous computational efforts, including their characteristics and visible limitations, are described. Finally, future perspectives and challenges are listed to motivate further developments.
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Affiliation(s)
- Gustavo A Vásquez-Montoya
- Departamento de Materiales y Minerales, Universidad Nacional de Colombia, Sede Medellín, Medellín, Colombia
| | - Juan S Danobeitia
- Department of Surgery, Division of Organ Transplantation, University of Wisconsin-Madison, Madison, WI, USA
| | - Luis A Fernández
- Department of Surgery, Division of Organ Transplantation, University of Wisconsin-Madison, Madison, WI, USA
| | - Juan P Hernández-Ortiz
- Departamento de Materiales y Minerales, Universidad Nacional de Colombia, Sede Medellín, Medellín, Colombia; Institute for Molecular Engineering, University of Chicago, Chicago, IL, USA; Laboratory for Molecular and Computational Genomics, UW Biotechnology Center, University of Wisconsin-Madison, Madison, WI 53706, USA.
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25
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Rai V, Dietz NE, Agrawal DK. Immunological basis for treatment of graft versus host disease after liver transplant. Expert Rev Clin Immunol 2016; 12:583-93. [PMID: 26795873 DOI: 10.1586/1744666x.2016.1145056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Graft versus host disease (GVHD) after liver transplant, although a rare disease, has a very high mortality rate. GVHD occurs due to immunoreactions caused by donor T lymphocytes and host cell surface antigens resulting in proliferation and clonal expansion of T lymphocyte. Migration of effector cells, including macrophages, NK cells and cytotoxic T lymphocyte, to the target organs such as skin, intestine and bone marrow results in skin rashes, diarrhea and bone marrow depression. GVHD is diagnosed by clinical symptoms, histopathological findings and by the presence of chimerism. The delayed diagnosis, opportunistic infections and lack of definitive treatment of post orthotopic liver transplant (OLT)-GVHD results in sepsis and multi-organ failure leading to very low survival rates. In this review, we have focused on early diagnosis and critically discuss novel treatment modalities to decrease the incidence of GVHD.
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Affiliation(s)
- Vikrant Rai
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Nicholas Edward Dietz
- b Department of Pathology , Creighton University School of Medicine , Omaha , NE , USA
| | - Devendra K Agrawal
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
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26
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Elfeki MA, Genco PV, Pungpapong S, Nakhleh RE, Nguyen JH, Harnois DM. Abatacept use in graft-versus-host disease after orthotopic liver transplantation: a case report. Transplant Proc 2015; 46:2422-5. [PMID: 25242798 DOI: 10.1016/j.transproceed.2014.06.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a rare, serious, fatal disease that occurs after orthotopic liver transplantation (OLT). CASE REPORT We treated a 60-year-old man who underwent OLT owing to familial amyloidosis. The patient developed fever on postoperative day 16. The fever was persistent and did not respond to antibiotic therapy. Cultures and radiologic studies were done and excluded infection as a potential cause. On postoperative day 26, a skin rash appeared on his chest, accompanied by diarrhea and persistent fever. The rash spread all over the trunk, neck, and arms, but spared the palms of his hands and soles of his feet. In the meantime, his blood cell count revealed pancytopenia. Skin biopsy was done and showed interface lymphocytic infiltrate that are largely centered on the dermal-epidermal junction, is consistent with GVHD (this pattern of rash distribution is unique and different from the rash of GVHD after hematopoietic stem cell transplant, which is confined to palms of the hands and soles of the feet; Fig 1). The diagnosis was confirmed by colonoscopy and multiple forceps biopsies, which revealed extensive crypt loss. After hematology consultation, the patient was treated by withdrawal of all immunosuppressive therapy coupled with abatacept infusion. Abatacept is a chimeric protein that inhibits T-lymphocytes and is approved by the US Food and Drug Administration for the treatment of rheumatoid arthritis. Interestingly, after second dose of abatacept the patient showed marked clinical and laboratory improvement. The patient was discharged after 47 days in a stable condition. CONCLUSION Because of the lack of a consensus for treatment of these patients, we report our experience with a male patient who had post-OLT GVHD and showed a marked improvement in response to abatacept.
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Affiliation(s)
- M A Elfeki
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - P V Genco
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - S Pungpapong
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - R E Nakhleh
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - J H Nguyen
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida
| | - D M Harnois
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida.
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Elfeki MA, Pungpapong S, Genco PV, Nakhleh RE, Nguyen JH, Harnois DM. Graft-versus-host disease after orthotopic liver transplantation: multivariate analysis of risk factors. Clin Transplant 2015; 29:1063-6. [PMID: 26358521 DOI: 10.1111/ctr.12627] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/26/2022]
Abstract
Graft-versus-host disease (GVHD) is a rare, fatal complication following orthotopic liver transplantation (OLT). To date, several risk factors have been proposed, but reports on these factors have been inconclusive. This is a retrospective, case-control study of prospectively collected data from 2775 OLTs performed at our institution. Eight cases of GVHD after OLT were diagnosed on the basis of the patient's clinical characteristics, and the findings were confirmed with skin and colonic biopsies. Each case was matched to three controls based on the diagnosis of liver disease, recipient's age, and blood group. Univariate and multivariate analyses were performed to identify risk factors associated with the development of GVHD after OLT. The univariate and multivariate analyses identified two main risk factors associated with development of GVHD in OLT recipients, a difference between recipient and donor age of >20 yr, and any human leukocyte antigen class I matches. Taking these two risk factors into consideration while matching prospective donors and recipients may reduce further incidence of GVHD in OLT patients. However, further studies are recommended to validate these findings.
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Affiliation(s)
- Mohamed A Elfeki
- Department of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA.,Department of Tropical Medicine and Hepatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Petrina V Genco
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Raouf E Nakhleh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Justin H Nguyen
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Denise M Harnois
- Department of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA
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Abstract
Many drugs and chemical agents can cause enteritis and colitis, producing clinical gastrointestinal side effects, the most common of which are diarrhoea, constipation, nausea and vomiting. Significant histological overlap exists between some patterns of medication or chemical injury and various disease entities. A particular medication may cause multiple patterns of injury and may mimic common entities such as coeliac disease, Crohn's disease, infectious enteritis and colitis. Thus, given the common absence of specific histopathological features, the diagnosis often relies upon thorough clinicopathological correlation. This review concentrates on selected examples of medication-induced injury of the intestinal tract in which the pathology can be recognized, particularly on biopsies, with a focus on newly described medication-induced gastrointestinal effects.
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Affiliation(s)
- Aoife J McCarthy
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Schulman JM, Yoon C, Schwarz J, Vagefi PA, Mully TW, Shinkai K. Absence of peripheral blood chimerism in graft-vs-host disease following orthotopic liver transplantation: case report and review of the literature. Int J Dermatol 2013; 53:e492-8. [PMID: 24372059 DOI: 10.1111/ijd.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Graft-vs-host disease (GVHD) is a rare and often fatal complication of orthotopic liver transplantation (OLT). The skin is frequently involved early in disease progression, but clinical and histopathological features may be nonspecific, presenting a diagnostic challenge. While the detection of peripheral blood chimerism has been proposed as a diagnostic criterion for post-OLT GVHD, it is not known whether peripheral blood chimerism is an absolute requirement for the diagnosis. MATERIALS AND METHODS We report a case of a 57-year-old man who developed post-OLT GVHD with cutaneous, enteric, and bone marrow involvement. We also review the epidemiology, pathogenesis, clinical presentation, histopathology, molecular diagnostic techniques, and treatment of GVHD following liver transplantation. RESULTS In our patient, analysis of the peripheral blood by short-tandem repeat polymerase chain reaction did not detect circulating donor lymphocytes. Donor lymphocytes were detected in the buccal mucosa, however, confirming the diagnosis. A review of chimerism patterns in 63 previously published cases of post-OLT GVHD reveals that this is the first reported case in which chimerism was absent in the peripheral blood but present in another site. CONCLUSIONS Peripheral blood chimerism may be absent in cases of post-OLT GVHD. A combination of clinical, histopathological, and molecular features is therefore required to make this challenging diagnosis.
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Affiliation(s)
- Joshua M Schulman
- Department of Dermatology, University of California, San Francisco, CA, USA
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Akbulut S, Yilmaz M, Yilmaz S. Graft-versus-host disease after liver transplantation: A comprehensive literature review. World J Gastroenterol 2012; 18:5240-8. [PMID: 23066319 PMCID: PMC3468857 DOI: 10.3748/wjg.v18.i37.5240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/11/2012] [Accepted: 06/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the factors affecting mortality in patients who developed graft-versus-host disease (GvHD) after liver transplantation (LT).
METHODS: We performed a review of studies of GvHD following LT published in the English literature and accessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases. Using relevant search phrases, 88 articles were identified. Of these, 61 articles containing most of the study parameters were considered eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a significant association (P < 0.05) were then subjected to multivariate analyses using a Cox proportional-hazards model.
RESULTS: The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 ± 15.5 years (range: 8 mo to 74 years), who met the inclusion criteria for the present study. Deaths occurred in 59 (67.8%) patients, whereas 28 (32.2%) survived after a mean follow-up period of 280.8 ± 316.2 d (range: 27-2285 d). Among the most frequent symptoms were rash (94.2%), fever (66.6%), diarrhea (54%), and pancytopenia (54%). The average time period between LT and first symptom onset was 60.6 ± 190.1 d (range: 2-1865 d). The Kaplan-Meier analysis revealed that pancytopenia (42.8% vs 59.3%, P = 0.03), diarrhea (39.2% vs 61.0%, P = 0.04), age difference between the recipient and the donor (14.6 ± 3.1 years vs 22.6 ± 2.7 years, P < 0.0001), and time from first symptom occurrence to diagnosis or treatment (13.3 ± 2.6 mo vs 15.0 ± 2.3 mo, P < 0.0001) were significant factors affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection before GvHD, etiological causes, time of onset, and donor type were not associated with mortality risk. The Cox proportional-hazards model, determined that an age difference between the recipient and donor was an independent risk factor (P = 0.03; hazard ratio, 7.395, 95% confidence interval, 1.2-46.7).
CONCLUSION: This study showed that an age difference between the recipient and donor is an independent risk factor for mortality in patients who develop GvHD after LT.
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Bhaskar B, Zeigenfuss M, Choudhary J, Fraser JF. Use of recombinant activated Factor VII for refractory after lung transplant bleeding as an effective strategy to restrict blood transfusion and associated complications. Transfusion 2012; 53:798-804. [DOI: 10.1111/j.1537-2995.2012.03801.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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How can pathologists help to diagnose late complications in small bowel and multivisceral transplantation? Curr Opin Organ Transplant 2012; 17:273-9. [DOI: 10.1097/mot.0b013e3283534eb0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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O'Brien KL, Pereira SE, Wagner J, Shadman M, Hendrie P, Nelson K, Gernsheimer TB, Price T, Reyes JD, Nester T. Transfusion-associated graft-versus-host disease in a liver transplant recipient: an unusual presentation and review of the literature. Transfusion 2012; 53:174-80. [DOI: 10.1111/j.1537-2995.2012.03686.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hodby K, Pamphilon D. Concise review: expanding roles for hematopoietic cellular therapy and the blood transfusion services. Stem Cells 2012; 29:1322-6. [PMID: 21739527 DOI: 10.1002/stem.689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hematopoietic stem cells (HSCs) have remained at the forefront of stem cell research for the past 50 years, since the therapeutic potential of bone marrow transplantation was realized. Uniquely, among stem and progenitor cells, research progress has been made in parallel between the laboratory benchtop and hospital bedside during this period. Integral to this work has been the role of the transfusion medicine services in the collection, storage, and processing of HSCs. The next decade promises to bring further developments: with new fields of cellular therapies, stem cell vaccination, and stem cell drug testing opening up. This article summarizes exciting areas of research concerning the behavior and potential clinical applications of HSCs. For the purposes of clarity, we describe in turn the trafficking and transfer of HSCs; ex vivo expansion of HSC units from different sources; and finally, applications of specifically selected subsets of hematopoietic cells and their progeny.
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Yuksekkaya HA, Arikan C, Tumgor G, Aksoylar S, Kilic M, Aydogdu S. Late-onset graft-versus-host disease after pediatric living-related liver transplantation for Langerhans cell histiocytosis. Pediatr Transplant 2011; 15:E105-9. [PMID: 21884342 DOI: 10.1111/j.1399-3046.2008.00899.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
GVHD is the most common and well-known cause of morbidity and mortality following allogeneic BM transplantation. The GVHD following OLT is an uncommon complication but has a high mortality and poses a major diagnostic and therapeutic challenge. We herein discussed a 12-month-old girl with multi-system LCH, who developed end-stage liver disease despite intensive chemotherapy. She underwent ABO-compatible liver transplantation at 28 months while in remission from LCH. The donor was her 26-yr-old father. Post-operative course was uneventful. The GVHD manifested with skin rash and BM suppression on post-transplant day 94 and confirmed by both microchimerism and skin biopsy. Prednisolone, basiliximab, and ATG were administered immediately but the bone marrow suppression was not improved and the patient died because of Candida sepsis at six-month post-transplant. GVHD after OLT should be keep in mind in patients with rash and BM suppression after liver transplantation. In LDLT, a patient who carries risk factors should investigated for optimal HLA matching.
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Affiliation(s)
- Hasan Ali Yuksekkaya
- Department of Pediatric Gastroenterology, Ege University School of Medicine, Izmir, Turkey
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Scherjon S, Lashley L, van der Hoorn ML, Claas F. Fetus specific T cell modulation during fertilization, implantation and pregnancy. Placenta 2011; 32 Suppl 4:S291-7. [PMID: 21592567 DOI: 10.1016/j.placenta.2011.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/28/2011] [Indexed: 02/07/2023]
Abstract
Recently there is an increasing interest in aspects of a more specific immunoregulation during pregnancy. Understanding these mechanism might have a broader application not only for reproductive immunology but also in general for biology and medicine. Especially the induction, already before conception, of feto-specific T cells with a possibly regulatory function gives a biological explanation of local immunotolerance at the maternal fetal interface, supporting the epidemiological evidence of a feto/paternal-specific immuneregulation. Understanding the expression of specific HLA-classes on trophoblast and the crosstalk of these antigens with various cell types, specifically modulated in the decidua, resulting in the secretion of cytokines and (angiogenic) chemokines has given us a more and more detailed understanding of this regulation. This regulation could be induced by fetal cells circulating in the mother (microchimerism) and from the interaction with fetal subcellular fractions as exosomes, but also from paternal antigens present in seminal fluid. Molecular interaction between paternal and fetal antigens and receptors in endometrium and the decidua are discussed. This review highlights besides uNK cells, especially the function of CD4+ and CD8+ T cells with a regulatory function in the context of recurrent miscarriage and pre-eclampsia. Besides HLA, also male-specific minor histocompatibility antigens and the genetic background for these pregnancy complications are discussed.
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Affiliation(s)
- S Scherjon
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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Osband AJ, Laskow DA, Mann RA. Treatment of acute graft-vs-host disease after simultaneous pancreas-kidney transplantation: a case report. Transplant Proc 2011; 42:3894-7. [PMID: 21094880 DOI: 10.1016/j.transproceed.2010.08.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/16/2010] [Accepted: 08/26/2010] [Indexed: 11/17/2022]
Abstract
Whereas neutropenia is common after solid-organ transplantation, graft-vs-host disease is unusual, especially after simultaneous pancreas-kidney transplantation. Most cases reported in the literature give few details of treatment approach, and all were fatal. A 45-year-old man with diabetes underwent simultaneous pancreas-kidney transplantation at our center, with organs from a female donor. Two weeks postoperatively, he was readmitted with fever, malaise, and neutropenia. A bone marrow biopsy specimen demonstrated that two-thirds of the lymphocytes were of female karyotype. Graft-vs-host disease was diagnosed. Aggressive immunosuppression therapy was administered; however, the patient died. To our knowledge, this is the first case report with specific details of a treatment protocol and sequential short tandem repeat data.
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Affiliation(s)
- A J Osband
- Kidney and Pancreas Transplant Center, Robert Wood Johnson Medical School, 10 Plum St, 7th Floor, New Brunswick, NJ 08901, USA.
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38
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Graft-versus-host disease after intestinal and multivisceral transplantation. Transplantation 2011; 91:219-24. [PMID: 21076376 DOI: 10.1097/tp.0b013e3181ff86ec] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Graft-versus-host-disease (GVHD) is a rare complication but carries a high mortality after transplantation. We retrospectively evaluated the incidence, risk factors and impact of this complication on the survival outcome of intestinal transplantation at a single center. METHODS 241 patients who underwent intestinal transplantation between March 1994 and July 2007 were analyzed for evidence of GVHD. A diagnosis of GVHD was based on clinical presentations and confirmed by histological findings. RESULTS Of the 241 patients, 22 (9.1%) were diagnosed as GVHD. The median time of GVHD onset was 75 days (range, 14-1,408). The incidence of GVHD was significantly higher in young children than in adults (13.2 versus 4.4%, P = 0.05). The multivisceral graft recipients were more likely to develop GVHD compared with those of isolated small bowel (12.4% versus 4.6%, P = 0.05). The presence of recipient splenectomy was significantly associated with the incidence of GVHD (P = 0.03). The inclusion of the spleen in the multivisceral grafts tended to be at an increased risk of GVHD compared with the group without the spleen transplant (12.3% versus 7.9%, P = 0.43). A total of 16 patients with GVHD died during the entire follow-up. Infection was the leading cause of death in 55% patients. CONCLUSIONS GVHD is a fatal and progressive complication of small bowel transplantation. Younger children, multivisceral graft recipients, and particularly those with splenectomy are at high risk of developing GVHD after transplantation.
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Souza LN, Faria DR, Dutra WO, Gomes CC, Gomez RS. Microchimerism in labial salivary glands of hematopoietic stem cell transplanted patients. Oral Dis 2010; 17:484-8. [PMID: 21504513 DOI: 10.1111/j.1601-0825.2010.01779.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Microchimerism has been extensively investigated in autoimmune diseases, which display similarities with graft-vs-host disease. This study was conducted to investigate the presence of microchimerism in minor salivary glands of hematopoietic stem cell transplanted patients, one of the targets of graft-vs-host disease. METHODS Labial salivary glands biopsy specimens from 11 stem cell transplanted patients were analysed. The samples were grouped in control (five specimens from a female-to-female transplantation) and study group (five glands from male-to-female transplantation). One male transplanted patient was used as a positive control. Fluorescence in situ hybridization with Y-chromosome probe and immunofluorescence with anticytokeratin AE1/AE3 and CD45 were used to identify Y-chromosome positive glandular epithelial cells from allogeneic hematopoietic stem cell transplanted patients. RESULTS In the study group, all samples were positive to Y-chromosome and cytokeratin AE1/AE3, in agreement with the pattern exhibited by male labial salivary gland. None of the samples from control group were positive to Y-chromosome despite being positive to cytokeratin AE1/AE3. Positivity to CD45 was not relevant. CONCLUSION Microchimerism in the labial salivary glands of sex-mismatched stem cell transplanted patients is a real phenomenon. Further studies are necessary to elucidate the impact of this phenomenon on the clinical status of stem cell transplanted patients.
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Affiliation(s)
- L N Souza
- Molecular Biology Laboratory, Dentistry School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Behling KC, Foster DM, Edmonston TB, Witkiewicz AK. Graft-versus-Host Disease-Like Pattern in Mycophenolate Mofetil Related Colon Mucosal Injury: Role of FISH in Establishing the Diagnosis. Case Rep Gastroenterol 2009; 3:418-423. [PMID: 21103265 PMCID: PMC2988941 DOI: 10.1159/000260903] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mycophenolate mofetil (CellCept®), a commonly used immunosuppressive drug in solid organ transplantation, has recently been shown to cause graft-versus-host disease (GVHD)-like changes in the gastrointestinal tract. On rare occasions, true GVHD has also been documented in the gastrointestinal tract of solid organ transplant patients. Because the treatment for these two entities is different, i.e. removal of the offending agent versus the administration of steroids, proper identification of the cause is imperative. We present a case of mycophenolate mofetil colitis mimicking grade I GVHD of the gut. In our study, we used fluorescence in situ hybridization for the Y chromosome to document the lack of male donor lymphocytes in the female recipient colon biopsy. We suggest that molecular techniques including fluorescence in situ hybridization could be used to discriminate between MMF-related colitis and true GVHD in order to help guide therapy.
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Affiliation(s)
- Kathryn C. Behling
- Department of Pathology, Thomas Jefferson University, Philadelphia, Pa., USA
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41
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Graft-versus-Host Disease Presenting With Pancytopenia After En Bloc Multiorgan Transplantation: Case Report and Literature Review. Transplant Proc 2009; 41:4431-3. [DOI: 10.1016/j.transproceed.2009.06.229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/25/2009] [Accepted: 06/01/2009] [Indexed: 12/11/2022]
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Osband AJ, Laskow DA, Berkowicz T, Mann RA. Quiz page July 2009. Fever and neutropenia following simultaneous pancreas-kidney transplantation. Graft-versus-host disease. Am J Kidney Dis 2009; 54:A35-7. [PMID: 19559333 DOI: 10.1053/j.ajkd.2009.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 03/10/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Adena J Osband
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Taieb A, Clavijo-Alvarez JA, Hamad GG, Lee WPA. Immunologic approaches to composite tissue allograft. J Hand Surg Am 2007; 32:1072-85. [PMID: 17826565 DOI: 10.1016/j.jhsa.2007.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 06/13/2007] [Indexed: 02/02/2023]
Abstract
This article discusses the immunologic principles and the most promising immunologic approaches for composite tissue allograft tolerance. We have previously reviewed some of the pharmacologic approaches for composite tissue allo-transplantation. In this review, we will summarize the range of options that may address the challenge of transplantation in reconstructive surgery.
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Affiliation(s)
- Aurèle Taieb
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Bluth MH, Reid ME, Manny N. Chimerism in the immunohematology laboratory in the molecular biology era. Transfus Med Rev 2007; 21:134-46. [PMID: 17397763 DOI: 10.1016/j.tmrv.2006.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dual or multiple cell populations, induced by chimeras, have been the subject of many studies. This long-standing fascination with chimeras has revealed a good deal of knowledge about human inheritance. Although historically most chimeras were caused by natural events, certain current medical intervention therapies are increasing the number of situations that can lead to a mixed cell population, that is, the chimeric condition, in humans. Medical therapies such as transfusion, stem cell transplantation, kidney transplantation, and artificial insemination induce temporary and sometimes permanent chimeras. Such natural or therapeutically induced presentations of chimerism can present challenging issues to the clinical immunohematology laboratory with regard to interpretation of results and subsequent patient management. The purpose of this review was to highlight some of these chimeric states and hypothesize how testing DNA from various tissues can cause apparent discrepancies between phenotype and genotype results.
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Tai HC, Zhu X, Hara H, Lin YJ, Ezzelarab M, Long C, Ball S, Ayares D, Cooper DKC. The pig-to-primate immune response: relevance for xenotransplantation. Xenotransplantation 2007; 14:227-35. [PMID: 17489863 DOI: 10.1111/j.1399-3089.2007.00401.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The allotransplantation of some solid organs can be associated with a graft-vs.-host (GVH) response from the activity of donor B or T cells. We have investigated whether there is a risk of a GVH response following pig-to-primate organ xenotransplantation. METHODS The responses of 16 pigs (six farm-housed wild-type and five wild-type housed under high herd health conditions [all designated WT], and 5 alpha1,3-galactosyltransferase gene-knockout [GT-KO] housed under high herd health conditions) to human (n = 6) and baboon (n = 6) peripheral blood mononuclear cells (PBMC) were determined. Assays included flow cytometry, complement-dependent cytotoxicity, and mixed lymphocyte reaction. RESULTS Anti-primate cytotoxic IgM antibodies were detected in the sera of all pigs, but anti-primate IgG antibodies were minimal. All pigs demonstrated a cellular proliferative response to primate PBMC that was equivalent to, or greater than, the allo response. The strength of the pig-to-primate GVH responses was proportional to the health status of the pigs, those from a high health status herd, particularly from a specific pathogen-free herd maintained under clean husbandry conditions, where colonization of the gastrointestinal tract may be reduced, having lower responses. CONCLUSIONS After pig organ transplantation in a primate, if the organ is from an early-weaned, early-segregated GT-KO pig, the strength of a GVH response is likely to be relatively weak. Although not investigated here, any GVH response is likely to be suppressed by the immunosuppressive therapy administered to the recipient to suppress the anti-donor immune response.
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Affiliation(s)
- Hao-Chih Tai
- Department of Surgery, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Assi MA, Pulido JS, Peters SG, McCannel CA, Razonable RR. Graft-vs.-host disease in lung and other solid organ transplant recipients. Clin Transplant 2007; 21:1-6. [PMID: 17302584 DOI: 10.1111/j.1399-0012.2006.00573.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Graft-vs.-host disease (GVHD) is an uncommon complication of solid organ transplantation. Herein, we report a case of GVHD occurring in a lung transplant recipient and review 29 reported cases of GVHD that complicated thoracic organ, and non-hepatic intra-abdominal organ transplantation. The major presenting clinical symptom of GVHD was skin rash. Less frequent clinical manifestations were cytopenia (16%), diarrhea (11%), and fever (5%). The mainstay of treatment was high-dose corticosteroids. The mortality rate was high (30%). The cause of death was mainly due to infection, suggesting that antimicrobial prophylaxis may improve the outcome of this potentially fatal complication.
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Affiliation(s)
- Maha A Assi
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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49
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Triulzi DJ. The above letter was sent to Triulzi et al.; Dr Triulzi offered the following reply. Transfusion 2006. [DOI: 10.1111/j.1537-2995.2007.01083.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith DM, Agura ED, Levy MF, Melton LB, Domiati-Saad R, Klintmalm G. Graft vs host disease following kidney transplantation using an '0 HLA antigen mismatched' donor. Nephrol Dial Transplant 2006; 21:2656-9. [PMID: 16627604 DOI: 10.1093/ndt/gfl174] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Douglas M Smith
- Transplant Immunology Laboratory, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
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