Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


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Oral Communications 4

21.318 - Novel therapies for Graft versus host disease in children following intestinal transplantation

Presenter: Shyla, Kishore, , United Kingdom
Authors: Shyla Kishore1, Sarah Lawson2, Phil Darbyshire2, Ogboli Malobi3, Mike Griffiths4, Girish Gupte1

Novel therapies for Graft versus host disease in children following intestinal transplantation

Shyla Kishore1, Sarah Lawson2, Phil Darbyshire2, Ogboli Malobi3, Mike Griffiths4, Girish Gupte1

1Hepatology, Birmingham Children's Hospital, Birmingham, United Kingdom; 2Haematology, Birmingham children's hospital, Birmingham, United Kingdom; 3Dermatology, Birmingham Children's hospital, Birmingham, United Kingdom; 4Immunology, Birmingham Children's hospital, Birmingham, United Kingdom

Background :  Graft versus host disease( GVHD)  is rare but life threatening complication seen after intestinal transplanation.
Aim:  To report on our experience  of the children who developed GVHD after intestinal transplantation.
Methodology:    A retrospective study review of electronic database and medical records to identify GVHD in intestinal transplant children.
Results: The number of small bowel transplants was 88 (n= 80 children) .GVHD was seen in 9 (Male: Female 2:7) children (11%), all were blood group compatible transplants, apart from one child. The Type of transplant was  Isolated small bowel n= 3, Liver and bowel n= 3, Modified multivisceral  with a median age of n= 1.3.5 yrs (1.25-9.17).  Median time of onset of skin GVHD from the date of transplant was 4 months (1.5-7 months). Median duration of GVHD is 4 months (1 month- 1year). All of the 9 children had skin involvement. , 3 had gut involvement and 2 had liver involvement, 3 children had involvement of eyes. All of them were treated with high dose steroids and 3 children were responsive to steroids. In  6 other children with aggressive GVHD additional treatement was used ( steroid + IL2 blocker) n=1, steroid + IL2 blocker + infliximab n=3, steroid . In addition to the above treatment two children had mesenchymal stem cells and one child had extracorporeal photopheresis (ECP). Outcome: 2 died due to GVHD,   5 had complete resolution of GVHD (1 mesenchymal stem cells), 2 have ongoing chronic GVHD (1 MSC+ ECP). Donor cell chimerism studies showed increase in CD3+T cells with flare up if the rash and reduction in the CD3+T cells with improvement of the rash.
Conclusion: Skin GVHD can be fatal and if refractory to steroids and aggressive, then escalation t to  second line treatment with MSC and ECP  is necessary for successful recovery .


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