A patient has developed a pruritic rash with fever around 15 days after renal transplantation, diagnosed as graft-versus-host disease. What is the prognosis?
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Hello, A patient has developed a pruritic rash with fever around 15 days after renal transplantation, diagnosed as graft-versus-host disease. What is the prognosis? He is 56 years old. Please leave your comments.
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@amitesh Acute GVHD may initially appear as a pruritic or painful rash (median onset, day 19 post-transplantation; range, 5-47 d). A hyperacute form of GVHD has been described as a disorder including fever, generalized erythroderma, and desquamation developing 7-14 days after transplantation. Acute GVHD is a clinicopathologic syndrome involving the skin, liver, and gut. Staging and grading is important in determining the management and prognosis and for comparing the results of immunosuppressive prophylaxis. The overall grade of acute GVHD is predictive of the patient's outcome, with the highest rates of mortality in those with grade IV, or severe, GVHD. The response to treatment is also predictive of outcomes in GVHD of grades II-IV. Patients with no response or with progression have a mortality rate as high as 75%, compared with 20-25% in those with a complete response. Factors associated with impaired survival are HLA-nonidentical marrow donors, liver abnormalities in addition to GVHD, and early time to onset and treatment of GVHD. Late GI symptoms (more than 100 days posttransplant) were reported in 71 allogeneic stem cell transplant patients. Following an endoscopy, 45 (63%) were diagnosed with GI-GVHD. Of these 45 patients, 39 (87%) had late acute GVHD. The median survival time from the first endoscopy was 8.5 months. The incidence of nonrelapse mortality at 6 months was 31% in patients with GI-GVHD compared to 19% in patients without GI-GVHD (P = 0.42). All patients with GI-GVHD were on steroid therapy, and close to one-third of these patients needed total parenteral nutrition.