Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA.
J Pediatr Surg. 2011 Sep;46(9):1732-8. doi: 10.1016/j.jpedsurg.2011.04.016.
Graft-versus-host disease (GVHD) after organ transplantation is a rare but life-threatening complication with very high mortality.
A retrospective review was performed of all patients undergoing small bowel or combined organ transplantation at a single institution during 2003 to 2009. Patients with donor T-cell chimerism were analyzed in detail for development of GVHD.
Thirty-two patients were included in the study. Of 32 patients, 11 (34%) had donor T-cell chimerism (range, 0%-53%) studies performed; 7 (64%) of those 11 patients demonstrated clinical features of GVHD. All patients who demonstrated GVHD had detectable donor T-cell chimerism. All patients with GVHD presented with skin involvement. Graft-versus-host disease responded to increased immune suppression therapy. Mortality was 43% (3/7) among patients with GVHD and was caused by multiorgan failure and sepsis in all cases.
Acute and chronic GVHD were observed frequently after combined solid organ transplantation and were associated with significant mortality and morbidity. Alloreactive donor T cells cotransplanted with the organ likely play a role in the pathophysiology because levels of donor-derived T-cell chimerism correlated with the clinical course of GVHD.
器官移植后的移植物抗宿主病（GVHD）是一种罕见但危及生命的并发症，死亡率极高。
对 2003 年至 2009 年在一家机构接受小肠或联合器官移植的所有患者进行回顾性研究。对具有供体细胞嵌合的患者进行了详细分析，以了解 GVHD 的发生情况。
研究纳入 32 例患者。在 32 例患者中，11 例（34%）进行了供体细胞嵌合研究（范围，0%-53%）；11 例中有 7 例（64%）表现出 GVHD 的临床特征。所有出现 GVHD 的患者均存在可检测到的供体细胞嵌合。所有出现 GVHD 的患者均有皮肤受累。GVHD 对增加免疫抑制治疗有反应。GVHD 患者的死亡率为 43%（3/7），所有病例均因多器官衰竭和脓毒症导致死亡。
联合实体器官移植后常发生急性和慢性 GVHD，与显著的死亡率和发病率相关。与器官一起移植的同种异体反应性供体细胞可能在发病机制中起作用，因为供体 T 细胞嵌合水平与 GVHD 的临床病程相关。
