83-P: GVHD IN MVT AND SMALL INTESTINAL TRANPLANTATION HSCT AS SAVAGE THERAPY

Aim Graft-versus-host disease (GVHD) after solid organ transplantation is a rare but fatal complication. The highest 5% to 10% reported after small intestine transplantation. The combination of chronic host immune suppression, minimal leukocyte antigen (HLA) matching and an inflammacion is capable of activating donor effector T cells all creating an environment for proliferation of donor alloreactive effector T cells resulting in acute GVHD. Purpose of this study is to propose therapeutic help in patients that underwent small bowel transplantation with GVHD no order therapeutic alternative with a fatal outcome. Methods Five patients that underwent multivisceral and insolated intestinal transplantation, these patients had no CPRA or DSA, induction immunosupression with ATG, Solumedrol and maintenance with Prograf and Medrol. GVHD was determined by clinical,pathological and Chimerism correlation. Chimerism was determined by SBT in CD3+. Donor/recipient allelic ratios were calculated simultaneous with absolute lymphocyte counts (ALC). Small bowel biopsy was assessed for rejection and GVHD. Results One adult and one pediatric patient underwent multivisceral transplantation develop GVHD. Donor T-cell Chimerism was detected as early as postoperative day 16 this donor T-cell Chimerism ranged from 0% to 93.6%; simultaneous CD4/CD8 ratio varied from 0. 1 to 1.3. Histopathological finding were seen at their native colon in these patients. Conclusions Graft-versus-host disease is a rare but potentially lethal complication after solid organ transplantation with a very high reported mortality of 75% to 100% in the adult and 20 to 30% in pediatric population after isolated small bowel transplantation. In this study, these patients respond with ATG for the rejection but with no recover of their Bone Marrow we propose for this patient’s savage therapy with HSCT, saving the cells prior transplant and offering in cases of no recovery to avoid fatal complications of the serious infections.