TY - CHAP M1 - Book, Section TI - Complications of Stem Cell Transplant A1 - Rozenfeld, Ranna A. PY - 2018 T2 - The PICU Handbook AB - Definition: Pro-inflammatory syndrome affecting the skin, liver, and gastrointestinal (GI) tract, typically within 100 days of hematopoietic stem cell transplant; immunocompetent transplanted cells mount an inflammatory response to cells in an immunosuppressed host.Skin: Most commonly affected organ, commonly maculopapular eruption, can progress to bulla formation and epidermal necrosisGastrointestinal: Symptoms include watery diarrhea, severe abdominal pain, GI bleeding or ileus (endoscopy and biopsy are recommended for diagnosis when possible)Hepatic: Cholestatic jaundice most common, but can progress to hepatic failureSee Table 58-1 for staging and grading of GVHDTherapy:First-line therapy is corticosteroids (decrease inflammatory cytokines that propagate acute GVHD)Skin GVHD typically responds most quickly to steroid therapyVariety of second-line therapies include polyclonal (ATG) and monoclonal antibodies, TNF-blockade (infliximab, etanercept), and calcineurin inhibitorsSupportive care: Organ specific, including wound care, antimotility agents, bowel rest, ursodeoxycholic acid, and antimicrobial prophylaxis SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1152488766 ER -