title: Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation.
abstract: OBJECTIVE
  Graft-versus-host disease (GVHD) after organ transplantation is a rare but life-threatening complication with very high mortality.
  
  
  METHODS
  A retrospective review was performed of all patients undergoing small bowel or combined organ transplantation at a single institution during 2003 to 2009. Patients with donor T-cell chimerism were analyzed in detail for development of GVHD.
  
  
  RESULTS
  Thirty-two patients were included in the study. Of 32 patients, 11 (34%) had donor T-cell chimerism (range, 0%-53%) studies performed; 7 (64%) of those 11 patients demonstrated clinical features of GVHD. All patients who demonstrated GVHD had detectable donor T-cell chimerism. All patients with GVHD presented with skin involvement. Graft-versus-host disease responded to increased immune suppression therapy. Mortality was 43% (3/7) among patients with GVHD and was caused by multiorgan failure and sepsis in all cases.
  
  
  CONCLUSIONS
  Acute and chronic GVHD were observed frequently after combined solid organ transplantation and were associated with significant mortality and morbidity. Alloreactive donor T cells cotransplanted with the organ likely play a role in the pathophysiology because levels of donor-derived T-cell chimerism correlated with the clinical course of GVHD.
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Chu Ri
authors.initials: CR
authors.lastname: Shin
authors.forename: Jaimie
authors.initials: J
authors.lastname: Nathan
authors.forename: Maria
authors.initials: M
authors.lastname: Alonso
authors.forename: Nada
authors.initials: N
authors.lastname: Yazigi
authors.forename: Samuel
authors.initials: S
authors.lastname: Kocoshis
authors.forename: Gregory
authors.initials: G
authors.lastname: Tiao
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D046528:Chimerism; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation; D008297:Male; D016377:Organ Transplantation; D012189:Retrospective Studies; D013601:T-Lymphocytes; D014019:Tissue Donors