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Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-two patients with previous hepatic compromise who underwent allogeneic bone marrow transplant (BMT) for treatment of hematologic malignancy or other hematologic disease between 1984 and 1990 were chosen for the present study. After transplant, 19 (86.4%) of the patients developed hepatitis, including six cases (27.3%) of acute hepatitis, 12 (54.6%) of chronic hepatitis and one uncharacterized hepatitis. Nine chronic hepatitis patients were followed-up for 7-56.5 months (medium 35.5 months) with biochemistry studies and ultrasonography. Throughout the observation period, liver cirrhosis or hepatoma were not detected and no patients developed veno-occlusive disease. Furthermore patients who developed hepatitis after transplant had worse prognoses. Based on serial serological survey of the various hepatitis B virus (HBV) antigens and antibodies, we have found that most of the recurrent viral hepatitis in transplant patients could be attributed to the reactivation of the virus. In addition, the use of immunosuppressive drugs, persisting infection by HCV and the development of graft-versus-host disease may also play a role in modulating the course of viral hepatitis in BMT patients.
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PMID:Liver disease in patients with liver dysfunction prior to bone marrow transplantation. 162 24

Twenty patients who were positive for hepatitis B surface antigen (HBsAg) underwent allogeneic marrow transplant for malignancy or other underlying hematologic disease between 1975 and 1986. After transplant, one patient had serologic evidence of hepatitis B virus (HBV) reactivation whereas three patients had evidence of an immune response to HBV. Among four patients with serologic follow-up of 1 year or more, three remained positive for HBsAg and one became HBsAg negative. Six patients (30%) developed clinical evidence of venocclusive disease and seven patients (35%) developed acute graft-versus-host disease involving the liver, but the incidence of these complications was similar to that expected among patients who are not carriers of HBsAg. Three patients died with hepatorenal failure, but all three had venocclusive disease and the contribution of HBV infection to liver failure was unclear. Available liver specimens obtained at autopsy (six patients) or biopsy (two patients) all showed either HBsAg (one specimen) or hepatitis B core antigen (four specimens) or both (three specimens) by immunoperoxidase staining. Although HBV reactivation leading to hepatic failure has been reported among allogeneic marrow transplant recipients as well as other immunocompromised patients, we did not observe an increase in the incidence of severe liver disease after transplant among these 20 patients positive for HBsAg at the time of transplant, and do not consider positivity for HBsAg to be a contraindication to allogeneic marrow transplantation.
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PMID:Allogeneic marrow transplantation in patients positive for hepatitis B surface antigen. 198 95

Major histocompatibility complex antigens are critical to an animal's immune response. In most animals, the extreme polymorphism of MHC molecules complicates studies of the role of this complex in the immune response. In mice, however, MHC haplotype-homozygous inbred strains have been developed which are invaluable in the study of the immune system and the search for immune response genes. The human MHC bears many similarities to its murine equivalent with regard to antigen structure and polymorphism; furthermore, a number of combinations of specific MHC alleles between HLA-B and HLA-DR/DQ (extended haplotypes) are found in people more commonly than predicted by individual allele frequencies. Over 30 percent of Caucasian haplotypes are extended haplotypes, and over 55 percent of individuals have at least one extended haplotype. Examples of the same extended haplotype, even in unrelated individuals, should either all have or lack any gene within the MHC region. The value of considering extended haplotypes in searching for associations between the MHC and diseases, or immune response, is shown in three examples: congenital adrenal hyperplasia, hepatitis B immunization, and transfusion-associated graft-versus-host disease.
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PMID:The major histocompatibility complex: the value of extended haplotypes in the analysis of associated immune diseases and disorders. 229 6

Forty-three patients with hematopoietic disease were treated with intensive chemotherapy and radiotherapy, followed by allogeneic bone marrow transplantation (BMT) from 28 HLA-identical and 10 one to two antigen haploidentical sibling donors and autologous BMT (5 cases). Of these cases, there were 21 with acute nonlymphocytic leukemia (ANLL), 5 with acute lymphocytic leukemia (ALL), 6 with chronic myelocytic leukemia (CML), 2 with Hodgkin's disease (HD), 8 with severe-form aplastic anemia (SAA) and 1 with thalassemia. Complications of BMT were evaluated including acute graft-versus-host disease (GVHD), interstitial pneumonia (IP), veno-occlusive liver disease (VOD), abnormalities of liver function (LF), and alteration of hepatitis B virus (HBV) markers. In thirty-three patients who were followed up for more than 3 months, we found that the incidence of moderate to severe acute GVHD (9.1%) and IP (two cases, 4.7%) were low. No VOD occurred in our series. During the follow-up period, 27 out of 35 patients (77%) had high alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels, even up to 1000 U/liter; however, only one patient succumbed to a hepatitis-related complication. Previous hepatic damage from HBV infection before BMT does not appear to increase the risk of posttransplant morbidity and mortality.
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PMID:Complications of bone marrow transplantation in Chinese. 232 72

Five patients, three with severe aplasia and two with acute leukaemia have been treated by bone marrow transplantation (BMT). Four are alive and well with excellent graft function. One showed engraftment but died of acute graft-versus-host disease (GVH); this patient and his donor were hepatitis B antigen positive. Three show evidence of mild chronic GVH, two patients requiring control by immunosuppressive therapy. Bone marrow transplantation (BMT) has now become an established method of treatment in severe aplasia and in acute leukaemia and our results serve to emphasise this. The clinical and organisational problems associated with BMT are discussed.
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PMID:Bone marrow transplantation for acute leukaemia and severe marrow aplasia: an analysis of five patients. 703 45

Serum antibodies to hepatitis C virus (HCV) were tested for inpatients undergoing allogeneic BMT to determine the risk of acquiring HCV infection and the role of HCV in posttransplant liver complications. The HCV seroconversion rate was evaluated according to the date of BMT and blood donor screening at the time. Anti-HCV antibodies (anti-HCV) were detected with a second-generation ELISA and confirmed with a second-generation radioimmunoblot assay. All patients received leukocyte-depleted blood products and most received apheresis platelet concentrates. One hundred twenty of 181 consecutive patients transplanted from January 1987 to December 1991 were anti-HCV-negative before BMT, had at least 6 months of follow-up, and were thus evaluated for the seroconversion rate. Before screening for non-A, non-B hepatitis, 14% of the patients seroconverted to HCV (0.44% per unit transfused). After introduction of screening for alanine aminotransferase and antibodies to hepatitis B core antigen the risk of seroconversion was 4% per patient (0.26% per unit). When, in addition, blood was screened for anti-HCV the risk fell to 1.6% (0.03% per unit). Positive anti-HCV status before and after BMT was not predictive of veno-occlusive disease, liver graft-versus-host disease (GVHD), or death due to liver dysfunction. In contrast, the risk of chronic hepatitis was significantly increased.
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PMID:Hepatitis C virus infection and allogeneic bone marrow transplantation. 750 88

Allogeneic bone marrow transplant patients are severely immunocompromised during the immediate posttransplant period, and the risk for common and opportunistic infections may persist for many months. The role of reimmunization for these patients, however, remains unsettled. We briefly review current concepts regarding the recapitulation of immunity from the totipotential hematopoietic stem cells in the donor marrow. The fact that various components of the new immune system mature at different rates can have clinical consequences with regard to specific infections. Most previously immunized patients become antibody seronegative within a few months after allogeneic marrow transplantation. Adoptive transfer of specific antibody-producing cells from the donor to the recipient has been demonstrated in small clinical trials, and is augmented when both donor and recipient are vaccinated. Passive transfer of immunity is more easily achieved to recall antigens than to neoantigens. Primary immunization requires prolonged antigenic stimulation and mature T-cell function or help from natural killer cells. Most healthy patients generate adequate antibody titers to vaccinations that are given 12 months after transplantation, but the presence of chronic graft-versus-host disease can diminish the response. Currently available vaccines have been evaluated in marrow transplant patients. Protein antigens such as tetanus and diphtheria toxoids are more immunogenic than polysaccharide antigens such as pneumococcal vaccine. The new polysaccharide-protein conjugate vaccines, such as the Hemophilus influenzae type b vaccine, also appear more immunogenic. Inactivated poliovirus vaccine has been used successfully. Relatively few data are available about hepatitis B or influenza vaccines. The literature supports the use of standard vaccines in allogeneic bone marrow transplant patients. However, more data on the optimal methods and timing of immunization are needed. We present guidelines for a reimmunization schedule.
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PMID:Reimmunization after allogeneic bone marrow transplantation. 770 53

To investigate the causes of impaired liver function (LF)* after BMT, 88 patients were included for analysis of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, transplant methods, preconditioning regimens, and graft-versus-host disease (GVHD). Fifty of them (56.8%) developed abnormal LF after BMT and among them, 29 (32.9%) developed chronic hepatitis (CH). By univariate analysis, HCV infection, pretransplant abnormal LF, allogeneic BMT, and preconditioning regimen with total body irradiation were all significantly related to higher incidence of post-BMT impaired LF. However, only HCV infection, pretransplant abnormal LF, and acute GVHD were associated with higher incidence of CH. By multivariate logistic regression analysis, HCV infection and pretransplant abnormal LF were the two most significant interpreters for abnormal LF, especially for CH (odds ratios: 7.86 and 4.735, respectively) after BMT. Although the incidence of abnormal LF was found high in this study, there was no significant disadvantage in terms of survival for patients who developed abnormal acute and chronic liver function after BMT. However, a long-term follow-up is needed to evaluate survival pathology of CH, such as liver cirrhosis and hepatoma.
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PMID:Liver disease after bone marrow transplantation--the Taiwan experience. 773 60

In Taiwan, a country with 21 million people, 388 bone marrow transplants (BMTs), 308 allografts and 80 autografts, were performed in 5 BMT centers from November 1983 to October 1993. The commonest indications were leukemia, aplastic anemia, lymphoma and thalassemia. Campaigns promoting an unrelated marrow donor registry were started in August 1993 and recruited approximately 26,000 volunteers. A peripheral stem cell program is just beginning. The overall results of BMT in Taiwan are comparable to other countries. The complications of BMT are similar to Western series, except that acute GVHD was rarer in one large series; this observation needs further study. A particular indication for allogeneic BMT in Taiwan is thalassemia, accounting for 10% of all patients. Disease-free survival after BMT for thalassemia is 44%; graft rejection is the major cause of treatment failure. Another important issue is the role of hepatitis B virus (HBV) in BMT, since the prevalence of HBV infection in Taiwan is very high (> 90%). Abnormal liver function is currently the most common complication and might be related to HBV. Among nearly 100 allogeneic BMTs with HBV carriers as either donor or recipient, 2 patients (approximately 2%) died of HBV-related hepatic failure. Whether the HBV status of the donor and recipient is an important prognostic factor remains to be defined.
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PMID:Bone marrow transplantation in Taiwan: an overview. 792 Feb 98

We report two cases of hepatitis B virus reactivation following allogeneic bone marrow transplantation (BMT) for severe aplastic anemia and acute myelocytic leukemia. The presence of antibodies to HBsAg, HBeAg and HBcAg prior to transplant indicated previous infection with hepatitis B virus (HBV). These antibodies disappeared 2 and 4 months after the onset of chronic graft versus host disease (GVHD) following immunosuppressive treatment, but HBsAg reappeared in their sera 6 and 10 months later, respectively. This suggests that chronic GVHD and immunosuppressive drugs can reactivate HBV in HBsAb-positive patients, most likely because of the decrease in quality and function of helper T cells and B cells during chronic GVHD to induce clearance of HBV antibodies and reactivation of HBV. Our observation confirms that patients with HBsAb, HBeAb and HBcAb present in their sera should not be considered to have 'immunity' to HBV after BMT.
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PMID:Reactivation of hepatitis B virus in two chronic GVHD patients after transplant. 814 96


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