Management of Graft vs Host Disease Following Intestinal Transplantation

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Abstract

Purpose: We present four patients with multi-visceral transplant (MVT) complicated by graft-versus-host disease (GvHD). Methods: We reviewed 26 cases following MVT for incidence of GvHD. Four patients that received MVT between 2011-2022 were evaluated for outcomes following surgery, including patient characteristics, diagnosis, organs involved, treatment, complications, and outcomes. Results: Four patients receiving MVT developed GvHD. 75% were male, median age at transplant was 45.75 (range 39-54), three were white, and one was black. Three patients presented for MVT due to pancreatic neuroendocrine tumor with liver metastasis and had GvHD which affected the skin. The other patient presented for MVT due to alcoholic cirrhosis complicated by portal and splenic thrombosis and chronic pancreatitis and had GvHD which affected the skin and bone marrow. All four patients had liver, pancreas, and small bowel transplants and received steroids. One patient with skin involvement also received photopheresis and etanercept. The patient with bone marrow involvement also received etanercept. Graft and patient survival at one and three years for those with skin involvement was 100% (3/3) and 50% (1/2) and for bone marrow involvement was 0% (0/1) and 0% (0/1) respectively. Infection within one month of GvHD diagnosis occurred in 33% (1/3) of patients with skin involvement (acute bacterial pneumonia) and 100% (1/1) with bone marrow involvement (septic shock). There were no signs of CMV or transplant rejection within one month of GvHD diagnosis. In patients where induction agents were noted, three received thymoglobulin and one also received rituximab. At GvHD diagnosis, all four patients were on prednisone. Of those with skin involvement, two were on tacrolimus with one also on solumedrol, and a third was on everolimus. The patient with bone marrow involvement initially had a blood STR of <1% donor and 99% recipient and a skin STR of 17% donor and 83% recipient. Retesting showed only recipient DNA two weeks after. Two patients with skin involvement had STR available. One had a blood STR of <1% donor and 99% recipient and a skin STR of 6% donor and 94% recipient while the second had a skin STR of 18% donor and 82% recipient. In patient one, retesting showed only recipient DNA two weeks after. Patient two was not retested. The patient with bone marrow involvement expired due to septic shock from E.coli, Klebsiella pneumoniae and Candida. Conclusions: GvHD occurs when the primary T cells of the allogenic grafted tissue recognize the host's proteins as foreign resulting in an immune response against the host. Biopsy and pathologic evaluation are required for diagnosis. High clinical suspicion for GvHD in MVT is necessary as early recognition and treatment improve outcomes. CITATION INFORMATION: Gupta D., Nagai S., Muszkat Y., Beltran N., Jafri S. Management of Graft vs Host Disease Following Intestinal Transplantation AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: D.Gupta: None. S.Nagai: None. Y.Muszkat: n/a. N.Beltran: n/a. S.Jafri: Speakers Bureau;; Gilead, Takeda, Abbvie.

PubMed ID

Not assigned.

Volume

23

Issue

Suppl 1

First Page

S733

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