Graft-v-host (GvH) reactions or GvH disease may be a complicating event after clinical small-bowel transplantation for two main reasions. Firstly, possibly as a result of malnutrition, the immune system of the recipient of a small-bowel allograft may be primarily compromised. Secondly, as a result of immunosuppressive therapy, the immunocompetence of the recipient might bei impaired more severely than that of the lymphoid tissues which are transferred with the allogeneic graft. Experimental evidence for the latter possibility is available in a report by KIRKMAN et al. (1984), who found that, in rats, cyclosporine A treatment limited to 1 week suppressed the rejection of small-bowel allografts, but did not prevent the occurrence of GvH disease in the parent —> F1hybrid combination. Thus, it is conceivable that the immunocompetent allogeneic lymphocytes within the graft could overcome the immune resistance of the host and induce GvH disease.
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