GVHD is
mainly associated with allogenic hematopoietic stem cell transplantation, and
occurs much less frequently after transplantation of immunologically active
solid organs such as liver and small intestine. GVHD after solid organ
transplantation(SOT) is a very rare and frequently lethal complication caused
by the engraftment and proliferation of allograft-associated lymphocytes in the
immunosuppressed recipient, with subsequent immune-mediated attack by
donor-origin effector cells directed against HLA-disparate host tissues. SOT-GVHD
occurs most frequently following small bowel and liver transplantation,
followed by lung and kidney transplantation in decreasing order of frequency. Risk factors for SOT-GVHD are the quantity of lymphoid tissue in the
donor organ, greater degrees of HLA match between donor and recipient
and recipient age over 65 years. Given
there are immune system related tissue when one does solid transplants such as
small bowel or liver is not uncommon.
80 cases of
GVHD after liver transplant were reported in 2008, with published incidence
rates of 1-2%. worldwide. GVHD is the consequence of
an immunologic reaction of engrafted lymphoid cells against the tissues of the
host. It is known that transient lymphocyte chimerism
occurs in recipients of SOT, and in fact it is thought to be necessary for the
establishment of organ tolerance; however, lymphocyte chimerism usually rapidly
decreases over time so that by the third postoperative week not allowing the
risk of GVHD.
Only 4
cases of kidney transplantation
associated GVHD ( what I found) have been reported. Typical symptoms and signs
of GVHD are skin rash, severe diarrhea, and the elevation of total bilirubin,
but these findings were often attributed by drug reactions or infections. These
may make the delay of GVHD diagnosis. The earliest time frame reported is
17 days after transplantation and latest up to 240 days following it. Majority of those cases presented with
diarrhea or rash and 50% mortality.
Specific tests have been used in diagnosis of GVHD. One is
detection of macrochimerism which was defined as more than 1% donor nucleated
cells in the peripheral blood of recipient, and the other is single-tandem
repeat (STR) DNA analysis which quantifies relative amounts of different DNA in
a single tissue sample. A
gastrointestinal source based disease usually reveals apoptotic cells in the
endoscopy or colonoscopy findings.
A recent
article discusses a case report
from Korea. The other 3 cases have been from Japan and USA.
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