title: Graft-versus-host Disease After Intestinal or Multivisceral Transplantation: A Scandinavian Single-center Experience.
abstract: BACKGROUND
  Graft-versus-host disease (GVHD) that develops after intestinal or multivisceral transplantation is difficult to diagnose and is associated with high morbidity and mortality.
  
  
  METHODS
  The objectives of this study were to investigate the incidence, clinical picture, risk factors, and outcome of GVHD in a Scandinavian cohort of patients who underwent intestinal or multivisceral transplantation during a period of 16 years (1998-2014). All transplanted patients (n = 26) were retrospectively analyzed with respect to donor- and recipient-derived risk factors. The diagnosis of GVHD was based on clinical signs, chimerism analyses of leukocytes, and histopathologic findings in biopsy specimens.
  
  
  RESULTS
  Five of 26 patients (19%) were diagnosed with GVHD, of which three had skin GVHD, one had skin and bone marrow GVHD, and one had passenger leukocyte syndrome. Only multivisceral-transplanted patients developed GVHD. Risk factors for development of GVHD were an underlying tumor diagnosis and neoadjuvant chemo- or brachytherapy administered before intestinal transplantation. All patients were given high-dose corticosteroids as first line treatment for their GVHD, and all survived their episodes of GVHD.
  
  
  CONCLUSIONS
  The risk of GVHD appears to be increased in recipients of multivisceral transplantations who received chemotherapy due to an underlying malignancy. The reasons may be the large amount of lymphoid tissue in these types of grafts, and the cytotoxic effects of the malignancy and chemotherapy on healthy recipient tissues. These patients should be monitored closely for the development of GVHD.
authors.affiliation: Department of Hematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: julia.cromvik@vgregion.se.
authors.forename: J
authors.initials: J
authors.lastname: Cromvik
authors.affiliation: Department of Gastroenterology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Varkey
authors.affiliation: Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Herlenius
authors.affiliation: Department of Hematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: J-E
authors.initials: JE
authors.lastname: Johansson
authors.affiliation: Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Wennerås
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000637:transplantation*; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014019:Tissue Donors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous / Q000009:adverse effects; D014781:Viscera / Q000637:transplantation*