Weng F L, Pancoska C, Patel A M
Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA.
Am J Transplant. 2008 Apr;8(4):881-3. doi: 10.1111/j.1600-6143.2008.02150.x. Epub 2008 Feb 19.
Acute graft-versus-host disease (GVHD) is a rare complication of pancreas transplantation. We describe a 54-year-old male with type 1 diabetes who received a zero-antigen mismatched pancreas-after-kidney transplant from a pancreas donor who was homozygous at the HLA-B, -Cw, -DR, and -DQ alleles. Starting on postoperative day (POD) #22, the patient developed persistent fevers. Workup was notable only for low-grade cytomegalovirus viremia, which was treated. The fevers eventually disappeared. On POD #106, the patient was noted to have a diffuse erythematous rash. A skin biopsy was consistent with GVHD. Short tandem repeat DNA analysis of both peripheral blood lymphocytes and skin demonstrated mixed chimerism, confirming the diagnosis of GHVD. Soon after diagnosis, the patient developed pancytopenia and fevers and died of multiorgan failure on POD #145. Transplant clinicians should consider GVHD as a possible, although admittedly rare, cause of fevers of unknown origin in recipients of pancreas transplants.
急性移植物抗宿主病（GVHD）是胰腺移植的一种罕见并发症。我们描述了一名54岁的1型糖尿病男性患者，他接受了来自一名在HLA - B、- Cw、- DR和 - DQ等位基因上均为纯合子的胰腺供体的零抗原错配肾后胰腺移植。术后第22天起，患者出现持续发热。检查仅发现低度巨细胞病毒血症，已进行治疗，发热最终消失。术后第106天，患者被发现有弥漫性红斑皮疹。皮肤活检结果符合GVHD。对外周血淋巴细胞和皮肤进行短串联重复DNA分析显示存在混合嵌合体，确诊为GVHD。确诊后不久，患者出现全血细胞减少和发热，并于术后第145天死于多器官功能衰竭。移植临床医生应将GVHD视为胰腺移植受者不明原因发热的一种可能病因，尽管其确实罕见。
