Assuntos
Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Guias de Prática Clínica como Assunto , Ultrassonografia Doppler/estatística & dados numéricos , Canadá , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Padrões de Prática Médica/normas , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Sociedades Médicas , Ultrassonografia Doppler/métodosRESUMO
Chronic graft-versus-host disease (cGVHD) is a common complication following allogeneic stem-cell transplantation (SCT). Past studies have implicated the persistence of host antigen-presenting cells (APCs) in GVHD. Our objective was to determine the frequency of host Langerhans cells (LCs) in normal skin post-SCT and ask if their persistence could predict cGVHD. Biopsies of normal skin from 124 sex-mismatched T-cell-replete allogenic SCT recipients were taken 100 days post-transplant. Patients with acute GVHD and those with <9 months of follow-up were excluded and prospective follow-up information was collected from remaining 22 patients. CD1a staining and X and Y chromosome in-situ hybridization were performed to label LCs and to identify their host or donor origin. At 3 months, 59 ± 5% of LCs were host derived. The density of LCs and the proportion of host-derived LCs were similar between patients that did or did not develop cGVHD. Most LCs in the skin remained of host origin 3 months after SCT regardless of cGVHD status. This finding is in line with the redundant role of LCs in acute GVHD initiation uncovered in recent experimental models.
