310.6: RISKS FACTORS FOR THE DEVELOPMENT OF GRAFT-VERSUS-HOST DISEASE (GVHD) AFTER INTESTINAL AND MULTIVISCERAL TRANSPLANTATION

Introduction: Graft versus host disease (GVHD) after intestinal and multivisceral transplantation occurs more frequently when compared to other solid organ transplants. This study reports the incidence, location and outcomes for GVHD patients after intestinal transplantation. Analysis was performed in order to establish risks factors in a high volume center Methods: Medical records were reviewed from the entire intestinal transplant database from 2003 to 2018. The diagnoses of GVHD were based on clinical features, chimerism assays and pathologic specimens. For analysis, a p< 0.05 was considered to have statistical significance Results: During this period, a total of 272 intestinal transplants were performed, with 23 patients (8.5%) being diagnosed with GVHD. The median time to onset was 79 days, with a 100% of cases diagnosed within the first year after transplant. Chimerism data was available for 18 patients and it was positive in 17 with a range of 2 – 98%. The skin was the most frequent affected organ. Immunosuppression was augmented in all cases. After univariate and multivariate analysis the main risks factors for the development of GVHD were retransplantation (p=0.005), multivisceral transplant (p=0.003) and colon-inclusive grafts (p=0.02). Donor thymoglobulin administration was not associated with GVHD risk reduction. Patient survival was severely affected by GVHD, with a one-year mortality of 39%, mainly due to infectious complications. Conclusion: This study suggests a strong association between Multivisceral transplants as well as retransplants and, interestingly, colon inclusive-grafts with the development of GVHD. This might be in the context of an increased amount of donor-derived lymphoid tissue at the time of transplant. This information regarding immunological derived complications and GVHD - risks factors should be considered at the time of graft selection.