title: Successful treatment of acute severe graft-versus-host-disease in a pancreas-after-kidney transplant recipient: case report.
abstract: The development of acute graft-versus-host-disease (GVHD) in recipients of pancreas transplants is a rare and quite often a fatal post-transplantation complication. We present a 38-year-old male with a longstanding history of type 1 diabetes mellitus and end-stage kidney disease, with a living unrelated kidney transplant from his wife for 3 years, who received an enteric-drained 5-antigen HLA-mismatched deceased-donor pancreas. Five weeks after transplantation, he presented with spiking fevers, severe skin rash, diarrhea, pancytopenia, and increasingly abnormal liver function tests. Skin biopsies were consistent with grade 3 acute GVHD. The patient was treated for GVHD with escalated doses of tacrolimus, pulse doses of steroids, and basiliximab. He was discharged after a 4-week hospital stay with complete resolution of his rash, fever, abnormal liver enzymes, and leukopenia. He remained in good health with excellent kidney and pancreas allograft function 3 years later.
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: S
authors.initials: S
authors.lastname: Guy
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: A
authors.initials: A
authors.lastname: Potluri
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: G
authors.initials: G
authors.lastname: Xiao
authors.affiliation: Division of Dermatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: M L
authors.initials: ML
authors.lastname: Vega
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: G
authors.initials: G
authors.lastname: Malat
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: K
authors.initials: K
authors.lastname: Ranganna
authors.affiliation: Division of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: C
authors.initials: C
authors.lastname: Cusack
authors.affiliation: Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: alden.doyle@drexelmed.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: Doyle
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D005938:Glucocorticoids / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D016035:Pancreas Transplantation; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D016559:Tacrolimus; D008775:Methylprednisolone