Acute graft-versus-host disease following simultaneous pancreas-kidney transplantation: a review of the literature

Abstract

【Objective】 Acute graft-versus-host disease (GVHD) in pancreas transplant is a rare but lethal complication. Most of the reported cases have died of sepsis or multiple organ failure within a few months of onset. Because of its rarity, the risks of GVHD have not been well understood. Recently, a few reports successfully showed treated cases of GVHD after pancreatic transplant for the first time in the last 20 years. This is a review of GVHD cases in pancreas transplant with particular emphasis on the clinical importance of donor-dominant human leukocyte antigen (HLA) one-way 0-mismatch.

【Data Source and Data Extraction】 We queried PubMed in search of articles describing GVHD in pancreas transplant. The reported cases of the past 20 years were reviewed. We summarized the data on baseline characteristics, treatment, and mortality of GVHD in pancreas transplant.

【Results】 Fourteen cases were reviewed; nine patients were deceased and five survived. Among 10 cases with reported HLA combinations, three (30%) were donor-dominant HLA one-way 0-mismatched cases, and all three cases were fatal regardless of type of treatment.

【Conclusion】 Accumulation of GVHD cases in pancreas transplant contributed to a better understanding of the postoperative morbidity and treatment. Still, the presence of donor-dominant HLA one-way 0-mismatch seems to be a risk factor of GVHD and poor treatment response. The application of pancreas transplant for those patients should be carefully determined.