title: Graft-versus-host disease after intestinal and multivisceral transplantation.
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.
authors.affiliation: Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
authors.forename: Guosheng
authors.initials: G
authors.lastname: Wu
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Eddie
authors.initials: E
authors.lastname: Island
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000637:transplantation; D018183:Transplantation Chimera / Q000276:immunology; D055815:Young Adult