Purpose

This study reports the incidence, location, and outcomes of graft-versus-host disease (GVHD) at an active intestine transplant center. Subgroup analysis is employed to assess for risk factors for the development of GVHD.

Methods

Records from an active transplant center were reviewed for all patients receiving an intestine transplant. Pathology reports were reviewed to establish the diagnosis and location of GVHD. Pharmacy records were reviewed in documented cases to assess therapeutic interventions.

Results

A total of 236 intestine transplants were performed with 34 (15%) patients developing GVHD. The mean time to disease onset was 126 days, with all but three patients being diagnosed in the first year post-transplant. Skin lesions were the most common manifestation of GVHD and seen in all but one patient. Other sites of disease included lungs, bone marrow, oral mucosa, colon, and brain, with disease in the lungs, brain, and bone marrow being universally fatal. In adults, the incidence of GVHD was 15%, with the incidence increasing from 5% in isolated intestine to 14% in modified multivisceral and 19% in multivisceral recipients. Pediatric patients had a slightly higher incidence at 17%, but in contrast to adults the incidence between transplant types was nearly equal (17% isolated intestine and 18% multivisceral). All patients with GVHD were treated with pulse steroids, followed by a steroid taper. This was generally successful for GVHD not involving the lungs and bone marrow. GVHD after 1-year post-transplant was rare, suggesting the development of some level of tolerance.

Conclusion

Overall, 15% of patients receiving an intestine transplant developed GVHD. GVHD in the lungs and bone marrow is universally fatal. In adults, increasing graft volume was associated with an increasing risk of GVHD. A similar association was not observed in pediatric intestine recipients. Further research should focus on determining patients at highest risk for GVHD to allow development of a therapeutic plan to prevent complications.

CITATION INFORMATION: Clouse J, Kubal C, Ekser B, Fridell J, Mangus R. Graft-versus-Host Disease in Intestine Transplantation. Am J Transplant. 2017;17 (suppl 3).

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