Gulbahce H Evin, Brown Charlotte A, Wick Myra, Segall Miriam, Jessurun Jose
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis, USA.
Am J Clin Pathol. 2003 Apr;119(4):568-73. doi: 10.1309/395B-X683-QFN6-CJBC.
We identified 10 solid organ transplant recipients with a histologic diagnosis of graft-vs-host disease (GVHD). Histologic slides were reviewed, and information on the transplant, HLA match, and blood product transfusion history was obtained. Molecular testing to evaluate the presence of donor lymphocytes (chimerism) was done in 1 case. All patients underwent at least 1 gastrointestinal biopsy; 1 patient also underwent a skin biopsy and 1 patient a liver biopsy; all specimens showed grade I to IV acute GVHD. Six patients had a diagnosis of GVHD within 3 months of blood product transfusion and/or solid organ transplantation, which is the time frame in which GVHD reportedly occurs after solid organ transplantation; 4 patients had a distant history of blood product transfusion or solid organ transplantation. In 1 patient, a molecular technique using the polymorphic marker DIS80 documented donor lymphocytes in the colonic tissue and blood (chimerism). Although histologic findings of GVHD are quite specific, they are not pathognomonic. A GVHD-like histologic pattern can be seen in other conditions such as drug reactions and viral infections. Demonstration of donor lymphocytes in the involved organ helps support the diagnosis of GVHD in questionable cases.
我们确定了10例经组织学诊断为移植物抗宿主病（GVHD）的实体器官移植受者。回顾了组织学切片，并获取了有关移植、HLA配型和血液制品输血史的信息。对1例患者进行了评估供体淋巴细胞（嵌合体）存在情况的分子检测。所有患者均接受了至少1次胃肠道活检；1例患者还接受了皮肤活检，1例患者接受了肝脏活检；所有标本均显示为I至IV级急性GVHD。6例患者在输注血液制品和/或实体器官移植后3个月内被诊断为GVHD，这是据报道实体器官移植后GVHD发生的时间范围；4例患者有血液制品输血或实体器官移植的远期病史。在1例患者中，使用多态性标记DIS80的分子技术在结肠组织和血液中记录到了供体淋巴细胞（嵌合体）。虽然GVHD的组织学表现相当特异，但并非具有诊断意义。在其他情况如药物反应和病毒感染中也可见到类似GVHD的组织学模式。在可疑病例中，在受累器官中证实存在供体淋巴细胞有助于支持GVHD的诊断。
