International Journal of Clinical & Experimental Dermatology(IJCED)
ISSN: 2476-2415 | DOI: 10.33140/IJCED
Impact Factor: 1.9
Toxic Epidermal Necrolysis and Graft versus Host Disease after Hematopoietic and Liver Transplantation: A Review
Abstract
Juaquito Jorge, Areta Kowal-Vern, Henry Chi Hang Fung, Stathis J Poulakidas
Background: Although rarely reported, Graft versus Host Disease (GvHD) and Toxic Epidermal Necrolysis (TEN) may complicate recovery in patients who undergo hematopoietic cell, and organ transplantation. Skin manifestations can appear clinically similar or overlap. The objective of this study was to determine whether there are any parameters, which distinguished these two conditions during transplantation.
Methods: A literature search for TEN only and combined TEN/GvHD cases after hematopoietic or liver transplantation between 1970 and 2015 was performed.
Results: Of 34 cases, there were 14 cases of TEN and 20 of combined TEN/GvHD after hematopoietic or liver transplantation. Patients with TEN had a median age of 41 (range 22-56) years compared to patients with TEN/ GvHD who had a median age of 29 (range 18-52) years. Percent total body surface area (TBSA) skin involvement was a median of 50 (range 23-87) %TBSA in the TEN group and 55 (range 30-80) %TBSA in the TEN/GvHD group. Mortality was 71.4% in the TEN group (10 of 14) and 95% in those with concurrent TEN/GvHD (19 of 20).
Conclusions: Development of both TEN and GvHD after hematopoietic or liver transplantation heralded a poor prognosis. TEN was frequently precipitated by co-trimoxazole and allopurinol, medications frequently used during transplantation. GvHD was more likely to start before TEN if both were diagnosed. If Grade IV GvHD occurred, it was difficult to determine if TEN had also complicated the picture. More patients with HSCT developed TEN/GvHD compared to patients with BMT and liver transplants. Future treatment directions may utilize major histocompatibility complex genetic drug susceptibilities testing to prevent the development of TEN during the transplantation in vulnerable patients. Although still in the early stages, several studies have shown that cyclosporine, which is used to treat patients with GvHD, may also be beneficial in decreasing mortality in patients with TEN.