Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota.
Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota.
J Am Acad Dermatol. 2018 Jun;78(6):1097-1101.e1. doi: 10.1016/j.jaad.2017.12.050. Epub 2017 Dec 27.
Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare.
To investigate the dermatologic manifestations and clinical outcomes of SOT GVHD.
Systematic literature review of SOT GVHD.
After full-text article review, we included 61 articles, representing 115 patients and 126 transplanted organs. The most commonly transplanted organ was the liver (n = 81). Among 115 patients, 101 (87.8%) developed skin involvement. The eruption appeared an average of 48.3 days (range, 3-243 days) posttransplant and was pruritic in 5 of 101 (4.9%) cases. The eruption was described as morbilliform in 2 patients (1.9%), confluent in 6 (5.9%), and desquamative in 4 (3.9%) cases. In many cases, specific dermatologic descriptions were lacking. The mortality rate was 72.2%. Relative time of death was reported in 23 patients who died during the follow-up period. These patients died an average of 99.2 days (range, 22-270 days) posttransplant, or 50.9 days after the appearance of dermatologic symptoms. Frequent causes of death were sepsis and multiorgan failure.
Incomplete descriptions of skin findings and potential publication bias resulting in publication of only the most severe cases.
GVHD is a potentially fatal condition that can occur after SOT and often presents with a skin rash. We recommend that dermatologists have a low threshold to consider and pursue this diagnosis in the setting of post-SOT skin eruption.
实体器官移植（SOT）后发生移植物抗宿主病（GVHD）极为罕见。
探讨 SOT GVHD 的皮肤科表现和临床结局。
对 SOT GVHD 的文献进行系统综述。
经过全文筛选，共纳入 61 篇文献，代表 115 例患者和 126 个移植器官。最常移植的器官是肝脏（n=81）。在 115 例患者中，101 例（87.8%）出现皮肤受累。皮疹平均在移植后 48.3 天（范围 3-243 天）出现，其中 5 例（4.9%）有瘙痒。2 例（1.9%）患者皮疹表现为麻疹样，6 例（5.9%）为融合性，4 例（3.9%）为脱屑性。许多病例缺乏特定的皮肤科描述。死亡率为 72.2%。在随访期间死亡的 23 例患者报告了相对死亡时间。这些患者在移植后平均死亡 99.2 天（范围 22-270 天），或在出现皮肤症状后 50.9 天死亡。死亡的常见原因是脓毒症和多器官衰竭。
皮肤表现的描述不完整，以及潜在的发表偏倚导致仅发表最严重的病例。
GVHD 是一种潜在致命的疾病，可发生于 SOT 后，常表现为皮疹。我们建议皮肤科医生在 SOT 后出现皮疹时，要考虑并积极诊断这种疾病。
