Unusual presentation of graft-versus-host disease in pediatric liver transplant recipients

Evidence of late and recurrent disease

Antonio D. Pinna, Deborah Weppler, Mariana Berho, Michele Masetti, Werviston DeFaria, Tomoaki Kato, John F. Thompson, Camillo Ricordi, Andreas G. Tzakis

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Graft-versus-host disease (GvHD) is a multi-organ disease caused by mature donor T cells that are activated by alloantigens expressed by the host antigen-presenting cells. GvHD has been reported after solid organ transplantation with two principal presentations: humoral and cellular. In the cellular type of GvHD after liver transplantation the symptoms are identical to the GvHD after bone marrow transplant, except that the liver is spared because it lacks host antigens. We have described three cases of intestinal GvHD after pediatric liver transplant with an unusual recurrent late presentation in two patients. Two patients were female, and their age at the time of transplant was 8 and 9 months, respectively, and one was an 8- month-old male. They all received reduced liver allografts of identical blood type from three different donors. One patient received two doses of donor bone marrow cell infusion. Two patients received double immunosuppressive therapy constituted by tacrolimus at a dose of 0.05 mg/kg p.o.b.i.d, and steroids 10 mg p.o. daily. One patient received a triple drug immunosuppression with tacrolimus (0.05 mg/kg p.o. b.i.d.), steroids (10 mg p.o. daily) and mycophenolate mofetil (125 mg p.o.b.i.d.). Diagnosis of intestinal GvHD was confirmed histologically on intestinal biopsies performed at the time of presentation of the clinical symptoms or at autopsy.

Original languageEnglish (US)
Pages (from-to)236-242
Number of pages7
JournalPediatric Transplantation
Volume3
Issue number3
DOIs
StatePublished - Aug 1999
Externally publishedYes

Fingerprint

Graft vs Host Disease
Pediatrics
Liver
Tissue Donors
Tacrolimus
Transplants
Steroids
Mycophenolic Acid
Isoantigens
Organ Transplantation
Antigen-Presenting Cells
Immunosuppressive Agents
Bone Marrow Cells
Liver Transplantation
Immunosuppression
Allografts
Transplant Recipients
Autopsy
Bone Marrow
T-Lymphocytes

Keywords

  • Intestinal graft-versus-host disease
  • Liver transplantation
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Unusual presentation of graft-versus-host disease in pediatric liver transplant recipients : Evidence of late and recurrent disease. / Pinna, Antonio D.; Weppler, Deborah; Berho, Mariana; Masetti, Michele; DeFaria, Werviston; Kato, Tomoaki; Thompson, John F.; Ricordi, Camillo; Tzakis, Andreas G.

In: Pediatric Transplantation, Vol. 3, No. 3, 08.1999, p. 236-242.

Research output: Contribution to journalArticle

Pinna, Antonio D. ; Weppler, Deborah ; Berho, Mariana ; Masetti, Michele ; DeFaria, Werviston ; Kato, Tomoaki ; Thompson, John F. ; Ricordi, Camillo ; Tzakis, Andreas G. / Unusual presentation of graft-versus-host disease in pediatric liver transplant recipients : Evidence of late and recurrent disease. In: Pediatric Transplantation. 1999 ; Vol. 3, No. 3. pp. 236-242.
@article{4155884036964d6d9c5fd4861587463b,
title = "Unusual presentation of graft-versus-host disease in pediatric liver transplant recipients: Evidence of late and recurrent disease",
abstract = "Graft-versus-host disease (GvHD) is a multi-organ disease caused by mature donor T cells that are activated by alloantigens expressed by the host antigen-presenting cells. GvHD has been reported after solid organ transplantation with two principal presentations: humoral and cellular. In the cellular type of GvHD after liver transplantation the symptoms are identical to the GvHD after bone marrow transplant, except that the liver is spared because it lacks host antigens. We have described three cases of intestinal GvHD after pediatric liver transplant with an unusual recurrent late presentation in two patients. Two patients were female, and their age at the time of transplant was 8 and 9 months, respectively, and one was an 8- month-old male. They all received reduced liver allografts of identical blood type from three different donors. One patient received two doses of donor bone marrow cell infusion. Two patients received double immunosuppressive therapy constituted by tacrolimus at a dose of 0.05 mg/kg p.o.b.i.d, and steroids 10 mg p.o. daily. One patient received a triple drug immunosuppression with tacrolimus (0.05 mg/kg p.o. b.i.d.), steroids (10 mg p.o. daily) and mycophenolate mofetil (125 mg p.o.b.i.d.). Diagnosis of intestinal GvHD was confirmed histologically on intestinal biopsies performed at the time of presentation of the clinical symptoms or at autopsy.",
keywords = "Intestinal graft-versus-host disease, Liver transplantation, Pediatrics",
author = "Pinna, {Antonio D.} and Deborah Weppler and Mariana Berho and Michele Masetti and Werviston DeFaria and Tomoaki Kato and Thompson, {John F.} and Camillo Ricordi and Tzakis, {Andreas G.}",
year = "1999",
month = "8",
doi = "10.1034/j.1399-3046.1999.00043.x",
language = "English (US)",
volume = "3",
pages = "236--242",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Unusual presentation of graft-versus-host disease in pediatric liver transplant recipients

T2 - Evidence of late and recurrent disease

AU - Pinna, Antonio D.

AU - Weppler, Deborah

AU - Berho, Mariana

AU - Masetti, Michele

AU - DeFaria, Werviston

AU - Kato, Tomoaki

AU - Thompson, John F.

AU - Ricordi, Camillo

AU - Tzakis, Andreas G.

PY - 1999/8

Y1 - 1999/8

N2 - Graft-versus-host disease (GvHD) is a multi-organ disease caused by mature donor T cells that are activated by alloantigens expressed by the host antigen-presenting cells. GvHD has been reported after solid organ transplantation with two principal presentations: humoral and cellular. In the cellular type of GvHD after liver transplantation the symptoms are identical to the GvHD after bone marrow transplant, except that the liver is spared because it lacks host antigens. We have described three cases of intestinal GvHD after pediatric liver transplant with an unusual recurrent late presentation in two patients. Two patients were female, and their age at the time of transplant was 8 and 9 months, respectively, and one was an 8- month-old male. They all received reduced liver allografts of identical blood type from three different donors. One patient received two doses of donor bone marrow cell infusion. Two patients received double immunosuppressive therapy constituted by tacrolimus at a dose of 0.05 mg/kg p.o.b.i.d, and steroids 10 mg p.o. daily. One patient received a triple drug immunosuppression with tacrolimus (0.05 mg/kg p.o. b.i.d.), steroids (10 mg p.o. daily) and mycophenolate mofetil (125 mg p.o.b.i.d.). Diagnosis of intestinal GvHD was confirmed histologically on intestinal biopsies performed at the time of presentation of the clinical symptoms or at autopsy.

AB - Graft-versus-host disease (GvHD) is a multi-organ disease caused by mature donor T cells that are activated by alloantigens expressed by the host antigen-presenting cells. GvHD has been reported after solid organ transplantation with two principal presentations: humoral and cellular. In the cellular type of GvHD after liver transplantation the symptoms are identical to the GvHD after bone marrow transplant, except that the liver is spared because it lacks host antigens. We have described three cases of intestinal GvHD after pediatric liver transplant with an unusual recurrent late presentation in two patients. Two patients were female, and their age at the time of transplant was 8 and 9 months, respectively, and one was an 8- month-old male. They all received reduced liver allografts of identical blood type from three different donors. One patient received two doses of donor bone marrow cell infusion. Two patients received double immunosuppressive therapy constituted by tacrolimus at a dose of 0.05 mg/kg p.o.b.i.d, and steroids 10 mg p.o. daily. One patient received a triple drug immunosuppression with tacrolimus (0.05 mg/kg p.o. b.i.d.), steroids (10 mg p.o. daily) and mycophenolate mofetil (125 mg p.o.b.i.d.). Diagnosis of intestinal GvHD was confirmed histologically on intestinal biopsies performed at the time of presentation of the clinical symptoms or at autopsy.

KW - Intestinal graft-versus-host disease

KW - Liver transplantation

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=0032796714&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032796714&partnerID=8YFLogxK

U2 - 10.1034/j.1399-3046.1999.00043.x

DO - 10.1034/j.1399-3046.1999.00043.x

M3 - Article

VL - 3

SP - 236

EP - 242

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

IS - 3

ER -