title: Successful treatment for graft-versus-host disease after pancreas transplantation.
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.
authors.affiliation: Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Pediatrics and Surgery, School of Medicine, Taipei Veterans General Hospital Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jei wen
authors.initials: Jw
authors.lastname: Chang
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sageshima
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Adela
authors.initials: A
authors.lastname: Mattiazzi
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
keywords: graft-versus-host disease; pancreas transplantation; treatment