Graft-versus-host disease after liver and small bowel transplantation in a child.
An 8-month-old child with an immunodeficiency disorder characterized by abnormal lymphocyte function and by low IgG and IgA levels had combined liver and small bowel transplantation under tacrolimus and steroid immunosuppression for the treatment of short gut syndrome and hepatic cirrhosis. The patient developed an early postoperative episode of Pneumocystis carinii pneumonia, and a subsequent surgical complication, prompting discontinuance of tacrolimus. A skin rash eventually shown to be graft-versus-host disease (GVHD) developed in the flank on the 12th post-transplant day and gradually became generalized. Peritonitis, sepsis, multisystem organ failure including the liver allograft led to death on the 23rd post-operative day. The mechanisms leading to post-transplant GVHD under the specific circumstances in this case are discussed.
Reyes
J
J
University of Pittsburgh Medical Center, Department of Surgery, PA, USA.
Todo
S
S
Green
M
M
Yunis
E
E
Schoner
D
D
Kocoshis
S
S
Furukawa
H
H
Abu-Elmagd
K
K
Tzakis
A
A
Bueno
J
J
Starzl
T E
TE
D005076:Exanthema / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000209:etiology*; D006801:Humans; D017098:IgA Deficiency / Q000150:complications; D017099:IgG Deficiency / Q000150:complications; D007153:Immunologic Deficiency Syndromes / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D007511:Ischemia / Q000209:etiology; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008214:Lymphocytes / Q000276:immunology; D008775:Methylprednisolone / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000209:etiology; D010538:Peritonitis / Q000209:etiology; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D012778:Short Bowel Syndrome / Q000601:surgery; D016559:Tacrolimus / Q000627:therapeutic use
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone