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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)

The main objective of this report is to compare and contrast the type and frequency of neuropathological findings following liver, heart, lung, heart-lung, kidney and bone marrow transplantation and to provide an overview of the major systemic complications in patients that received allografts. This is a retrospective analysis of the complete autopsy records and clinical histories of 500 adults who underwent organ transplantation at the University of Pittsburgh Medical Center during the interval of March, 1981 through July, 1997. This study is based on the neuropathological and systemic findings among 225 liver, 101 heart, 40 lung, 28 heart-lung, 74 kidney and 32 bone marrow transplants. Clinico-pathological correlations were made. All patients received base-line immunosuppressive therapy with one or more of the following drugs: cyclosporine, corticosteroids and azathioprine. Since August, 1989, the primary immunosuppressive agent is FK-506 (Tacrolimus). Some patients received antilymphocyte globulin (OKT3), when acute rejection was imminent. Light microscopic examination of tissue sections, stained with hematoxylin and eosin and in some cases with special stains were made. Ultrastructural evaluation were also performed in selected cases. All of the studies were carried out at the University of Pittsburgh Medical Center, Department of Pathology, Neuropathology Division. Cerebrovascular complications were the most frequent and were seen in 51% of the liver, 59% of the heart, 58% of the lung, 50% of the heart-lung, 49% of the kidney and 44% of the bone marrow allografts. Aspergillus sp. infection was the most common of all CNS infections followed by viral, bacterial and protozoal. Primary Central Nervous System Lymphoma (PCNSL) was seen in 2% of the liver, and 2% of the heart recipients. Post transplant lymphoproliferative disorder (PTLD) involving the brain was seen in 2% of the liver allografts, 3% of the heart, and 7% of the heart-lung recipients. PTLD systemically was seen in 6% of the liver, 7% of the heart, 5% of the lung, 11% of the heart-lung and 4% of the kidney allografts. Graft-versus-host disease was seen only in 41% of the bone marrow recipients. There was no statistically significant difference between the incidence of the total CNS complications among the different organ transplant groups (p value > 0.10), but there was a statistically significant difference in the systemic complications among the organ transplant groups (p value < 0.001). In conclusion that immunocompromised patients with impaired cellular and humoral immunity are at risk for the development of opportunistic infections and hematologic abnormalities. PTLD appears to be different in its pathogenesis from that of PCNSL which occurs anew in the brain of these patients. The neurological complications may be reduced by earlier recognition and better understanding of their etiopathogenesis.
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PMID:The neuropathology of organ transplantation: comparison and contrast in 500 patients. 972 64

Allogeneic peripheral blood stem cell transplantation (allo PBSCT) is a recognized treatment modality for hematological malignancies resistant to conventional chemoradiotherapy. The post-transplant immune-mediated graft-versus-leukemia effect has major curative potential. In this case presentation, the allogeneic approach to resistant recurrent primary central nervous system (CNS) lymphoma using peripheral blood stem cells from an HLA identical sibling after immuno-suppressive non-myeloablative conditioning, was examined clinically. The patient in question had relapsing refractory primary CNS lymphoma and is the first to be treated with this modality. She developed early skin and liver-localized grade II graft-versus-host disease after allo PBSCT, which then responded to short-term treatment. Chimeric studies at the time showed 100% donor cells and repeated magnetic resonance imaging of the brain revealed gradual shrinkage of the tumor. Three months after transplant the cerebral mass was no longer evident and currently, 30 months after transplantation, the patient continues to be disease free. The absence of any signs of malignancy suggests the development of a durable graft-versus-lymphoma effect in this brain tumor and indicates that this effect may be achieved even after non-myeloablative conditioning.
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PMID:Graft-versus-lymphoma effect after allogeneic peripheral blood stem cell transplantation for primary central nervous system lymphoma. 1035 Mar 48