Journal of the American Academy of Dermatology · 2017
Dermatologic manifestations of solid organ transplantation-associated graft-versus-host disease: A systematic review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Kim Grace Y, Schmelkin Leah A, Davis Mark D P, El-Azhary Rokea A, Farrell Ann M, Meves Alexander, Lehman Julia S
Аннотация
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.
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.