Grace Y Kim1, Leah A Schmelkin2, Mark D P Davis3, Rokea A El-Azhary3, Ann M Farrell4, Alexander Meves3, Julia S Lehman5. 1. Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota. 2. Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota. 3. Department of Dermatology, Mayo Clinic, Rochester, Minnesota. 4. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota. 5. Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. Electronic address: lehman.julia@mayo.edu.
Abstract
BACKGROUND: Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare. OBJECTIVE: To investigate the dermatologic manifestations and clinical outcomes of SOT GVHD. METHODS: Systematic literature review of SOT GVHD. RESULTS: 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. LIMITATIONS: Incomplete descriptions of skin findings and potential publication bias resulting in publication of only the most severe cases. CONCLUSIONS: 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.
BACKGROUND:Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare. OBJECTIVE: To investigate the dermatologic manifestations and clinical outcomes of SOT GVHD. METHODS: Systematic literature review of SOT GVHD. RESULTS: 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. LIMITATIONS: Incomplete descriptions of skin findings and potential publication bias resulting in publication of only the most severe cases. CONCLUSIONS: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.
Authors: Lena Thin; Gerry Macquillan; Leon Adams; George Garas; Cynthia Seow; Paul Cannell; Bradley Augustson; Andrew Mitchell; Luc Delriveire; Gary Jeffrey Journal: Liver Transpl Date: 2009-04 Impact factor: 5.799
Authors: Douglas M Smith; Edward D Agura; Ken Ausloos; W Steves Ring; Rana Domiati-Saad; Goran B Klintmalm Journal: J Heart Lung Transplant Date: 2006-08-08 Impact factor: 10.247
Authors: Adam Weinstein; David Dexter; Debra L KuKuruga; Benjamin Philosophe; John Hess; David Klassen Journal: Transplantation Date: 2006-07-15 Impact factor: 4.939
Authors: Sven Kohler; Andreas Pascher; Guido Junge; Igor M Sauer; Marion Nagy; Constanze Schönemann; Martin Koch; Ulf Neumann; Johann Pratschke; Peter Neuhaus Journal: Transpl Int Date: 2008-02-04 Impact factor: 3.782