Successful treatment for graft-versus-host disease after pancreas transplantation
Graft‐versus‐host disease (GVHD) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report three cases of GVHD after pancreas transplantation with favorable outcomes. Patients with a history of kidney (and pancreas) transplantation...
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| Published in | Clinical transplantation Vol. 28; no. 2; pp. 217 - 222 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
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Blackwell Publishing Ltd
01.02.2014
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| Abstract | Graft‐versus‐host disease (GVHD) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report three cases of GVHD after pancreas transplantation with favorable outcomes. Patients with a history of kidney (and pancreas) transplantation subsequently received a pancreas (and kidney) transplantation (i.e., pancreas retransplantation or pancreas after kidney transplantation) and developed acute GVHD. All of them responded to increased immunosuppression (e.g., steroid bolus, antithymocyte globulin) and retained normal graft function. Because the clinical manifestations are non‐specific, vigilance is necessary to make an accurate diagnosis. We underscored the importance of a biopsy of involved organs and the clinicopathologic correlation in the early diagnosis of GVHD. Augmented immunosuppression to prevent progression from a self‐limited disease to life‐threatening pancytopenia or sepsis may be most critical to improve outcome. |
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| AbstractList | Abstract
Graft‐versus‐host disease (
GVHD
) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report three cases of
GVHD
after pancreas transplantation with favorable outcomes. Patients with a history of kidney (and pancreas) transplantation subsequently received a pancreas (and kidney) transplantation (i.e., pancreas retransplantation or pancreas after kidney transplantation) and developed acute
GVHD
. All of them responded to increased immunosuppression (e.g., steroid bolus, antithymocyte globulin) and retained normal graft function. Because the clinical manifestations are non‐specific, vigilance is necessary to make an accurate diagnosis. We underscored the importance of a biopsy of involved organs and the clinicopathologic correlation in the early diagnosis of
GVHD
. Augmented immunosuppression to prevent progression from a self‐limited disease to life‐threatening pancytopenia or sepsis may be most critical to improve outcome. Graft-versus-host disease (GVHD) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report three cases of GVHD after pancreas transplantation with favorable outcomes. Patients with a history of kidney (and pancreas) transplantation subsequently received a pancreas (and kidney) transplantation (i.e., pancreas retransplantation or pancreas after kidney transplantation) and developed acute GVHD. All of them responded to increased immunosuppression (e.g., steroid bolus, antithymocyte globulin) and retained normal graft function. Because the clinical manifestations are non-specific, vigilance is necessary to make an accurate diagnosis. We underscored the importance of a biopsy of involved organs and the clinicopathologic correlation in the early diagnosis of GVHD. Augmented immunosuppression to prevent progression from a self-limited disease to life-threatening pancytopenia or sepsis may be most critical to improve outcome. |
| Author | Tsai, Hsin-Lin Burke III, George W. Chen, Linda Ruiz, Phillip Ciancio, Gaetano Mattiazzi, Adela Chang, Jei wen Sageshima, Junichiro |
| Author_xml | – sequence: 1 givenname: Jei wen surname: Chang fullname: Chang, Jei wen organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA – sequence: 2 givenname: Junichiro surname: Sageshima fullname: Sageshima, Junichiro organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA – sequence: 3 givenname: Gaetano surname: Ciancio fullname: Ciancio, Gaetano organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA – sequence: 4 givenname: Adela surname: Mattiazzi fullname: Mattiazzi, Adela organization: Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, FL, Miami, USA – sequence: 5 givenname: Linda surname: Chen fullname: Chen, Linda organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA – sequence: 6 givenname: Hsin-Lin surname: Tsai fullname: Tsai, Hsin-Lin organization: Department of Pediatrics and Surgery, School of Medicine, Taipei Veterans General Hospital Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan – sequence: 7 givenname: Phillip surname: Ruiz fullname: Ruiz, Phillip organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA – sequence: 8 givenname: George W. surname: Burke III fullname: Burke III, George W. email: gburke@med.miami.edu organization: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA |
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| Cites_doi | 10.1111/j.1600-6143.2008.02150.x 10.1111/j.1600-6143.2012.04235.x 10.1016/S0140-6736(08)60690-X 10.1097/00007890-199706150-00025 10.3121/cmr.2.4.243 10.1016/j.transproceed.2010.08.058 10.1097/00007890-198003000-00009 10.1309/395BX683QFN6CJBC 10.1097/00007890-197410000-00001 10.1016/S0039-6060(05)80350-2 10.1097/00007890-199408150-00002 10.1046/j.1365-2141.1997.1112925.x 10.1002/(SICI)1096-8652(199607)52:3<236::AID-AJH23>3.0.CO;2-C 10.1097/01.tp.0000225832.47130.10 10.12659/AOT.883704 10.1097/00007890-198604000-00028 10.1097/00007890-200201270-00030 |
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| Keywords | treatment pancreas transplantation graft-versus-host disease |
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| References_xml | – volume: 63 start-page: 1685 year: 1997 article-title: Lethal graft‐versus‐host disease after simultaneous kidney‐pancreas transplantation publication-title: Transplantation – volume: 17 start-page: 133 year: 2012 article-title: Graft‐versus‐host disease after solid organ transplantation: a single center experience and review of literature publication-title: Ann Transplant – volume: 8 start-page: 881 year: 2008 article-title: Fatal graft‐versus‐host disease presenting as fever of unknown origin in a pancreas‐after‐kidney transplant recipient publication-title: Am J Transplant – volume: 29 start-page: 209 year: 1980 article-title: Role of mobile passenger lymphocytes in the rejection of renal and cardiac allografts in the rat. A passenger lymphocyte‐mediated graft‐versus‐host reaction amplifies the host response publication-title: Transplantation – volume: 73 start-page: 307 year: 2002 article-title: Successful outcome of acute graft‐versus‐host disease in a liver allograft recipient by withdrawal of immunosuppression publication-title: Transplantation – volume: 52 start-page: 236 year: 1996 article-title: In vivo CAMPATH‐1 monoclonal antibodies: a novel mode of therapy for acute graft‐versus‐host disease publication-title: Am J Hematol – volume: 97 start-page: 855 year: 1997 article-title: IBMTR Severity Index for grading acute graft‐versus‐host disease: retrospective comparison with Glucksberg grade publication-title: Br J Haematol – volume: 162 start-page: 547 year: 1986 article-title: Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation publication-title: Surg Gynecol Obstet – volume: 41 start-page: 544 year: 1986 article-title: Lethal graft‐versus‐host disease in a recipient of a pancreas‐spleen transplant publication-title: Transplantation – volume: 82 start-page: 127 year: 2006 article-title: Acute graft‐versus‐host disease in pancreas transplantation: a comparison of two case presentations and a review of the literature publication-title: Transplantation – volume: 18 start-page: 295 year: 1974 article-title: Clinical manifestations of graft‐versus‐host disease in human recipients of marrow from HL‐A‐matched sibling donors publication-title: Transplantation – volume: 42 start-page: 3894 year: 2010 article-title: Treatment of acute graft‐vs‐host disease after simultaneous pancreas‐kidney transplantation: a case report publication-title: Transplant Proc – volume: 62 start-page: 21 year: 1966 article-title: The Biology of graft‐versus‐host reactions publication-title: Harvey Lect – volume: 118 start-page: 392 year: 1995 article-title: Inclusion of peripancreatic lymph node cells prevents recurrent autoimmune destruction of islet transplants: evidence of donor chimerism publication-title: Surgery – volume: 371 start-page: 1579 year: 2008 article-title: Mesenchymal stem cells for treatment of steroid‐resistant, severe, acute graft‐versus‐host disease: a phase II study publication-title: Lancet – volume: 2 start-page: 243 year: 2004 article-title: Recent advances in the treatment of graft‐versus‐host disease publication-title: Clin Med Res – volume: 12 start-page: 3363 year: 2012 article-title: Advantage of rapamycin over mycophenolate mofetil when used with tacrolimus for simultaneous pancreas kidney transplants: randomized, single‐center trial at 10 years publication-title: Am J Transplant – volume: 119 start-page: 568 year: 2003 article-title: Graft‐vs‐host disease after solid organ transplant publication-title: Am J Clin Pathol – volume: 58 start-page: 269 year: 1994 article-title: Transfusion‐induced graft‐versus‐host disease after liver transplantation. Documentation using polymerase chain reaction with HLA‐DR sequence‐specific primers publication-title: Transplantation – ident: e_1_2_8_5_1 doi: 10.1111/j.1600-6143.2008.02150.x – volume: 62 start-page: 21 year: 1966 ident: e_1_2_8_10_1 article-title: The Biology of graft‐versus‐host reactions publication-title: Harvey Lect contributor: fullname: Billingham RE – ident: e_1_2_8_12_1 doi: 10.1111/j.1600-6143.2012.04235.x – ident: e_1_2_8_19_1 doi: 10.1016/S0140-6736(08)60690-X – ident: e_1_2_8_2_1 doi: 10.1097/00007890-199706150-00025 – ident: e_1_2_8_18_1 doi: 10.3121/cmr.2.4.243 – ident: e_1_2_8_6_1 doi: 10.1016/j.transproceed.2010.08.058 – ident: e_1_2_8_15_1 doi: 10.1097/00007890-198003000-00009 – ident: e_1_2_8_3_1 doi: 10.1309/395BX683QFN6CJBC – ident: e_1_2_8_13_1 doi: 10.1097/00007890-197410000-00001 – ident: e_1_2_8_16_1 doi: 10.1016/S0039-6060(05)80350-2 – ident: e_1_2_8_11_1 doi: 10.1097/00007890-199408150-00002 – ident: e_1_2_8_14_1 doi: 10.1046/j.1365-2141.1997.1112925.x – ident: e_1_2_8_20_1 doi: 10.1002/(SICI)1096-8652(199607)52:3<236::AID-AJH23>3.0.CO;2-C – ident: e_1_2_8_4_1 doi: 10.1097/01.tp.0000225832.47130.10 – volume: 162 start-page: 547 year: 1986 ident: e_1_2_8_8_1 article-title: Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation publication-title: Surg Gynecol Obstet contributor: fullname: Corry RJ – ident: e_1_2_8_7_1 doi: 10.12659/AOT.883704 – ident: e_1_2_8_9_1 doi: 10.1097/00007890-198604000-00028 – ident: e_1_2_8_17_1 doi: 10.1097/00007890-200201270-00030 |
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| Snippet | Graft‐versus‐host disease (GVHD) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report... Graft-versus-host disease (GVHD) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We herein report... Abstract Graft‐versus‐host disease ( GVHD ) after pancreas transplantation is a rare but serious complication: All previously reported cases were fatal. We... |
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| SubjectTerms | Adult Follow-Up Studies Graft vs Host Disease - drug therapy Graft vs Host Disease - etiology graft-versus-host disease Humans Immunosuppressive Agents - therapeutic use Male Middle Aged pancreas transplantation Pancreas Transplantation - adverse effects Pancreatic Diseases - complications Pancreatic Diseases - surgery Prognosis Randomized Controlled Trials as Topic Retrospective Studies treatment |
| Title | Successful treatment for graft-versus-host disease after pancreas transplantation |
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