Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
Transplantation. 2011 Jan 27;91(2):219-24. doi: 10.1097/TP.0b013e3181ff86ec.
Graft-versus-host-disease (GVHD) is a rare complication but carries a high mortality after transplantation. We retrospectively evaluated the incidence, risk factors and impact of this complication on the survival outcome of intestinal transplantation at a single center.
241 patients who underwent intestinal transplantation between March 1994 and July 2007 were analyzed for evidence of GVHD. A diagnosis of GVHD was based on clinical presentations and confirmed by histological findings.
Of the 241 patients, 22 (9.1%) were diagnosed as GVHD. The median time of GVHD onset was 75 days (range, 14-1,408). The incidence of GVHD was significantly higher in young children than in adults (13.2 versus 4.4%, P = 0.05). The multivisceral graft recipients were more likely to develop GVHD compared with those of isolated small bowel (12.4% versus 4.6%, P = 0.05). The presence of recipient splenectomy was significantly associated with the incidence of GVHD (P = 0.03). The inclusion of the spleen in the multivisceral grafts tended to be at an increased risk of GVHD compared with the group without the spleen transplant (12.3% versus 7.9%, P = 0.43). A total of 16 patients with GVHD died during the entire follow-up. Infection was the leading cause of death in 55% patients.
GVHD is a fatal and progressive complication of small bowel transplantation. Younger children, multivisceral graft recipients, and particularly those with splenectomy are at high risk of developing GVHD after transplantation.
移植物抗宿主病（GVHD）是一种罕见的并发症，但在移植后死亡率很高。我们回顾性评估了单一中心肠移植后发生该并发症的发生率、危险因素及其对生存结局的影响。
对 1994 年 3 月至 2007 年 7 月期间接受肠移植的 241 例患者进行分析，以确定有无 GVHD 的证据。GVHD 的诊断基于临床表现，并通过组织学发现得到证实。
241 例患者中，22 例（9.1%）诊断为 GVHD。GVHD 发病的中位时间为 75 天（范围 14-1408 天）。儿童患者的 GVHD 发生率明显高于成人（13.2%比 4.4%，P=0.05）。多器官移植患者比单纯小肠移植患者更易发生 GVHD（12.4%比 4.6%，P=0.05）。受体脾切除术与 GVHD 的发生率显著相关（P=0.03）。包含脾脏的多器官移植与不包含脾脏移植的患者相比，GVHD 的风险更高（12.3%比 7.9%，P=0.43）。共有 16 例 GVHD 患者在整个随访期间死亡。感染是 55%患者死亡的主要原因。
GVHD 是小肠移植的一种致命且进行性的并发症。年幼的儿童、多器官移植患者，特别是那些接受脾切除术的患者，在移植后发生 GVHD 的风险较高。
