FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2315015069> ?p ?o ?g. }

• W2315015069 endingPage "e10" @default.
• W2315015069 startingPage "e9" @default.
• W2315015069 abstract "Graft-versus-host disease (GVHD) occurs when donor lymphoid cells damage recipient tissues after allogeneic transplantation. Apart from bone marrow, GVHD occurrence after organ transplantation has been less common, with several series reported, for example, in liver transplantation literature: it has rarely been addressed in small bowel transplantation (˜10%). In this setting, GVHD remains a devastating complication (1–3): steroids are the cornerstone of treatment for GVHD, sometimes together with reduced FK dosage (Pittsburgh protocol) (4), and prognosis worsens dramatically for nonresponders. Affected adult patients often have a mortality rate greater than 80%, and over the last 20 years, the mortality for this complication has remained unchanged. There are several approaches to the treatment of steroid-resistant GVHD after small bowel transplantation: one is directly cytotoxic to effector cells of GVHD, such as thymoglobulin (4), OKT3, and sirolimus, whereas another option is to block the cytokines involved in its pathogenesis, such as infliximab (1) and interleukin-2 antagonist (5). Acute GVHD is the most common clinical feature, but chronic GVHD (3 months after transplantation) is a related but distinct syndrome: whereas acute GVHD characteristically involves skin and liver (sparing other tissues), distinctive features of chronic GVHD also include sicca syndrome (dry eyes and dry mouth) and lichenoid or sclerotic skin changes. Over the last 15 years, extracorporeal photopheresis has emerged as a safe and efficacious approach for management of steroid-resistant GVHD (acute or chronic) after bone marrow transplantation: lymphocytes are collected by a leukapheresis process and exposed ex vivo to psoralen and ultraviolet A treatment then reinfused into the patient. To our knowledge, this is the first reported case of successful treatment for chronic GVHD by extracorporeal photopheresis after bowel-abdominal wall transplantation in an adult recipient. CASE REPORT A 17-year-old girl was transplanted in June 2011 for chronic intestinal pseudo-obstruction (6) with a full bowel (small bowel plus colon) and abdominal wall graft, harvested from an 11-year-old male donor: alemtuzumab preconditioning followed by tacrolimus and steroids represented the immunosuppressive therapy (Table 1). The spleen was preserved during the transplantation. Four months later, the patient, aged 18 years, developed a pruritic, erythematous maculopapular skin rash on the upper and lower limbs with elevated liver function tests, consistent with an acute episode of GVHD, as confirmed by skin biopsy (showing sparse lymphocytic infiltrate in the superficial dermis and focal basal vacuolar degeneration in the epidermis with rare apoptotic bodies): this was treated with steroid therapy and a full course of thymoglobulin (Table 1). Multiagent infection prophylaxis was administered, with antibacterial, antifungal, and antiviral agents. As expected, the abdominal wall graft, taken from same bowel donor, was never involved by the disease (Fig. 1). The symptoms resolved. Seven months later, the patient presented with lichenoid skin lesion and dry eyes, clinical features of chronic GVHD, again confirmed at skin biopsy and by elevated liver function tests: cell subset was CD3+ (PAN T) 44% (normal range, 56–86) with CD4+/CD8+ ratio 0.34 (normal range, 1–2.7). The diagnosis of chronic GVHD, as opposed to recurrent acute GVHD, was based on clinical features typical of chronic GVHD (including lichen of the mouth and dry eyes) and the characteristic histology of the skin (7). Steroid therapy was increased again, in addition to a multiagent infection prophylaxis, and the patient underwent a full course of extracorporeal photopheresis (Table 1) despite leukopenia (supported by granulocyte colony-stimulating factor). Bone marrow or gastrointestinal tract was never involved by the disease and no adverse effects were reported apart from transient leukopenia. Donor T-cell chimerism (Fish test) improved from 4.4% (May 2012) to 0.4% (July 2012) during photopheresis, and after a 7-month follow-up, the patient is disease free with a functioning graft, normalized liver function tests, and immunosuppressed by FK and steroids (tapered to 25 mg) on a daily basis.TABLE 1: Immunosuppressive therapy and GVHD treatmentFIGURE 1: GVHD of upper limbs and trunk (abdominal wall transplant not involved by disease).DISCUSSION AND CONCLUSIONS GVHD is a serious complication presenting a major cause of posttransplantation morbidity and mortality: although there is a standard treatment for acute GVHD after intestinal transplantation, the therapy for chronic GVHD has been rarely debated so far (2). Since the first report of a successful treatment with extracorporeal photopheresis for chronic GVHD, several retrospective studies (with a variety in the number of patients involved and few prospective trials) have assessed its efficacy in steroid-refractory GVHD after bone marrow transplantation, but it has never been reported in a case of chronic GVHD after combined bowel-abdominal wall transplantation: one study reviewed 20 articles, with a total of 204 patients treated with photopheresis for chronic GVHD approximately 1 to 110 months from bone marrow transplantation. One hundred twenty-eight of them presented with skin and 84 presented with liver involvement: regression of clinical manifestations was observed in 76% of patients with skin and 48% with liver involvement, and overall survival was 79% (8, 9). In our case, skin response to the treatment was optimal with no active signs of disease and normalized liver function tests after both treatments for acute and chronic GVHD, consequently not requiring a liver biopsy. Treatment with extracorporeal photopheresis allowed a considerable reduction of steroid administration, resulting in a lower risk of infections and malignant diseases, but a longer follow-up will be necessary to evaluate the effects of this new strategy on long-term outcome after intestinal transplantation. Augusto Lauro 1 Mario Arpinati2 Chiara Zanfi1 Maria Cristina Morelli1 Antonia D’Errico-Grigioni3 Alberto Bagni3 Alessandro Dazzi1 Loris Pironi4 Antonio D. Pinna1 1 Liver and Multiorgan Transplant Unit St.Orsola University Hospital Bologna, Italy 2 Institute of Hematology and Medical Oncology “L. eA. Seràgnoli” St.Orsola University Hospital Bologna, Italy 3 Pathology Unit F. Addarii Institute of Oncology and Pathology St.Orsola University Hospital Bologna, Italy 4 Center for Chronic Intestinal Failure St.Orsola University Hospital Bologna, Italy" @default.
• W2315015069 created "2016-06-24" @default.
• W2315015069 creator A5008060231 @default.
• W2315015069 creator A5015623905 @default.
• W2315015069 creator A5049022216 @default.
• W2315015069 creator A5057777607 @default.
• W2315015069 creator A5061878594 @default.
• W2315015069 creator A5067281574 @default.
• W2315015069 creator A5070366828 @default.
• W2315015069 creator A5084559422 @default.
• W2315015069 creator A5088983987 @default.
• W2315015069 date "2013-07-27" @default.
• W2315015069 modified "2023-09-27" @default.
• W2315015069 title "Extracorporeal Photopheresis for Chronic GVHD" @default.
• W2315015069 cites W1983606382 @default.
• W2315015069 cites W2021593063 @default.
• W2315015069 cites W2024818927 @default.
• W2315015069 cites W2046584814 @default.
• W2315015069 cites W2049984714 @default.
• W2315015069 cites W2081235654 @default.
• W2315015069 cites W2083167331 @default.
• W2315015069 cites W2148040731 @default.
• W2315015069 doi "https://doi.org/10.1097/tp.0b013e318296fd3f" @default.
• W2315015069 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/23857006" @default.
• W2315015069 hasPublicationYear "2013" @default.
• W2315015069 type Work @default.
• W2315015069 sameAs 2315015069 @default.
• W2315015069 citedByCount "6" @default.
• W2315015069 countsByYear W23150150692017 @default.
• W2315015069 countsByYear W23150150692018 @default.
• W2315015069 countsByYear W23150150692021 @default.
• W2315015069 countsByYear W23150150692022 @default.
• W2315015069 countsByYear W23150150692023 @default.
• W2315015069 crossrefType "journal-article" @default.
• W2315015069 hasAuthorship W2315015069A5008060231 @default.
• W2315015069 hasAuthorship W2315015069A5015623905 @default.
• W2315015069 hasAuthorship W2315015069A5049022216 @default.
• W2315015069 hasAuthorship W2315015069A5057777607 @default.
• W2315015069 hasAuthorship W2315015069A5061878594 @default.
• W2315015069 hasAuthorship W2315015069A5067281574 @default.
• W2315015069 hasAuthorship W2315015069A5070366828 @default.
• W2315015069 hasAuthorship W2315015069A5084559422 @default.
• W2315015069 hasAuthorship W2315015069A5088983987 @default.
• W2315015069 hasBestOaLocation W23150150691 @default.
• W2315015069 hasConcept C141071460 @default.
• W2315015069 hasConcept C203014093 @default.
• W2315015069 hasConcept C2777630719 @default.
• W2315015069 hasConcept C2779338263 @default.
• W2315015069 hasConcept C2779972918 @default.
• W2315015069 hasConcept C2781468836 @default.
• W2315015069 hasConcept C2909675724 @default.
• W2315015069 hasConcept C2909962264 @default.
• W2315015069 hasConcept C2911091166 @default.
• W2315015069 hasConcept C71924100 @default.
• W2315015069 hasConceptScore W2315015069C141071460 @default.
• W2315015069 hasConceptScore W2315015069C203014093 @default.
• W2315015069 hasConceptScore W2315015069C2777630719 @default.
• W2315015069 hasConceptScore W2315015069C2779338263 @default.
• W2315015069 hasConceptScore W2315015069C2779972918 @default.
• W2315015069 hasConceptScore W2315015069C2781468836 @default.
• W2315015069 hasConceptScore W2315015069C2909675724 @default.
• W2315015069 hasConceptScore W2315015069C2909962264 @default.
• W2315015069 hasConceptScore W2315015069C2911091166 @default.
• W2315015069 hasConceptScore W2315015069C71924100 @default.
• W2315015069 hasIssue "2" @default.
• W2315015069 hasLocation W23150150691 @default.
• W2315015069 hasLocation W23150150692 @default.
• W2315015069 hasLocation W23150150693 @default.
• W2315015069 hasOpenAccess W2315015069 @default.
• W2315015069 hasPrimaryLocation W23150150691 @default.
• W2315015069 hasRelatedWork W1561760250 @default.
• W2315015069 hasRelatedWork W17521658 @default.
• W2315015069 hasRelatedWork W187139310 @default.
• W2315015069 hasRelatedWork W1968940559 @default.
• W2315015069 hasRelatedWork W1990834260 @default.
• W2315015069 hasRelatedWork W2155072866 @default.
• W2315015069 hasRelatedWork W2297197354 @default.
• W2315015069 hasRelatedWork W3123985525 @default.
• W2315015069 hasRelatedWork W3181433151 @default.
• W2315015069 hasRelatedWork W3205042091 @default.
• W2315015069 hasVolume "96" @default.
• W2315015069 isParatext "false" @default.
• W2315015069 isRetracted "false" @default.
• W2315015069 magId "2315015069" @default.
• W2315015069 workType "article" @default.