Dermatologic manifestations of solid organ transplantation-associated graft-versus-host disease: A systematic review.
J Am Acad Dermatol 2017;
78:1097-1101.e1. [PMID:
29288097 DOI:
10.1016/j.jaad.2017.12.050]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
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.
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