title: Graft-versus-host disease after solid organ transplantation: a single center experience and review of literature.
abstract: BACKGROUND
  Graft-versus-host disease (GVHD) is an uncommon cause of morbidity and mortality after solid organ transplantation that is most likely under-diagnosed. We describe our single center experience with three cases of GVHD diagnosed over a period of 15 years in a total of 2,271 solid organ transplant recipients.
  
  
  METHODS
  We describe three case reports: (1) a 3-week old neonate who developed GVHD 16 months after living-related liver transplant, (2) a 14-year old adolescent who developed GVHD 4 months following an unrelated cadaveric pancreas transplant and; (3) a 27-year old male who developed GVHD 18 days after simultaneous kidney-pancreas transplant from an unrelated donor. GVHD was confirmed through skin biopsies, engraftment profile from bone marrow biopsy and variable number tandem repeat analysis. Treatment strategies included use of corticosteroids and sirolimus monotherapy, corticosteroids and mesenchymal stromal cell therapy and reduction of immunosuppression. We observed that African-American race, sexual and HLA mismatching and cytomegalovirus infection may be high risk factors for development of GVHD following solid organ transplant.
  
  
  CONCLUSIONS
  GVHD continues to be a rare but fatal complication following solid organ transplantation that demands a high index of clinical suspicion for diagnosis and management. Future approaches may focus on early recognition of risk factors and improving treatment protocols using a combination of mesenchymal stromal cell transplantation with pharmacotherapy.
authors.affiliation: Department of Transplantation Surgery, Virginia Commonwealth University, Richmond, VA 23298, U.S.A. asharma@mcvh-vcu.edu
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Amy E
authors.initials: AE
authors.lastname: Armstrong
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Kimball
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: Anne L
authors.initials: AL
authors.lastname: King
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Kamar
authors.initials: K
authors.lastname: Godder
mesh_terms: D000293:Adolescent; D000328:Adult; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D006087:Graft vs Host Reaction; D006801:Humans; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D016035:Pancreas Transplantation / Q000276:immunology*; D011183:Postoperative Complications / Q000175:diagnosis*