Abstract:
BACKGROUND:Passenger lymphocyte-mediated graft-versus-host disease (GVHD) in solid organ transplantation (SOT-GVHD) is considered a rare complication, particularly among recipients of lung allografts. The risk of transfusion-associated GVHD (TA-GVHD) in solid organ transplants is also considered rare. The suspicion of either may be heralded by signs and symptoms of GVHD in the company of a population of passenger lymphocytes in excess of 1 percent (microchimerism). This case report illustrates the challenge of a patient who presented with macrochimerism both from the lung transplant allograft and from transfusions. STUDY DESIGN AND METHODS:Chimerism assessments of the pre- and posttransplant donor lung, and the recipient's aplastic marrow, were made using DNA-based polymerase chain reaction testing. RESULTS:Macrochimerism was observed in both the posttransplant aplastic host marrow and the engrafted donor lung, with the former predominantly consisting of lung donor lymphocytes and the latter a mixture of lung and presumably transfusion source donor lymphocytes. The pretransplant donor lung exhibited no GVHD-like pathology. CONCLUSION:This case demonstrates SOT-GVHD, with the unusual feature of concomitant macrochimerism from transfusions. SOT-GVHD likely predisposed this patient to the observed transfusion-associated macrochimerism. However, the dissociation between transfusion-attributable macrochimerism and attributable pathology is intriguing. Furthermore, the risk spectrum of transfusion-associated macrochimerism and TA-GVHD in solid organ transplant recipients with and without the complication of SOT-GVHD is unknown and warrants further study.
journal_name
Transfusionjournal_title
Transfusionauthors
Pavenski K,Kamel-Reid S,Wei C,Cserti-Gazdewich CMdoi
10.1111/j.1537-2995.2008.01835.xsubject
Has Abstractpub_date
2008-10-01 00:00:00pages
2190-6issue
10eissn
0041-1132issn
1537-2995pii
TRF01835journal_volume
48pub_type
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