Mawad R, Hsieh A, Damon L
Department of Internal Medicine, UCSF Medical Center, 505 Parnassus, M987, San Francisco, CA 94143, USA.
Transplant Proc. 2009 Dec;41(10):4431-3. doi: 10.1016/j.transproceed.2009.06.229.
Graft-versus-host disease (GVHD) is a dreaded complication of bone marrow and solid organ transplantation. Commonly affected organs include skin, liver, and the gastrointestinal tract, with bone marrow and renal involvement occurring more rarely. GVHD is less commonly seen with solid organ transplants. Fewer than 100 cases of GVHD have been reported in the literature following liver transplantation. We report a case of a 53-year-old woman who required a multiorgan transplant after a complicated postoperative course following paraduodenal hernia repair. She developed isolated pancytopenia approximately 4 months after receiving an en bloc transplant involving the liver, kidney, small bowel, and pancreas. No evidence of skin, gastrointestinal, or hepatic involvement was discovered. HLA typing of the peripheral blood revealed that 28% of patient peripheral blood was composed of donor lymphocytes. Bone marrow biopsy showed a markedly hypocellular marrow with 23% donor lymphocytes and 80% of the T-cell population from the donor as well. The patient began treatment for GVHD, including high-dose steroids, basiliximab, and rituximab. Unfortunately, she developed overwhelming sepsis and subsequently died. This case describes an instance of GVHD manifested by isolated pancytopenia after en bloc transplantation of multiple solid organs. GVHD is a rare, but serious complication of solid organ transplantation that can result in death. Although isolated bone marrow involvement is uncommon, it must be considered early to avoid a delay in diagnosis. This case also highlights an association of GVHD with multiorgan transplants, although this is incompletely characterized in the current literature.
移植物抗宿主病（GVHD）是骨髓移植和实体器官移植中令人恐惧的并发症。常见受累器官包括皮肤、肝脏和胃肠道，骨髓和肾脏受累较少见。GVHD在实体器官移植中较少见。肝移植后文献报道的GVHD病例少于100例。我们报告一例53岁女性病例，该患者在十二指肠旁疝修补术后经历复杂的术后过程后需要进行多器官移植。在接受包括肝脏、肾脏、小肠和胰腺的整块移植后约4个月，她出现了单纯全血细胞减少。未发现皮肤、胃肠道或肝脏受累的证据。外周血HLA分型显示患者外周血28%由供体淋巴细胞组成。骨髓活检显示骨髓明显细胞减少，有23%的供体淋巴细胞，且T细胞群的80%也来自供体。患者开始接受GVHD治疗，包括大剂量类固醇、巴利昔单抗和利妥昔单抗。不幸的是，她发生了严重败血症，随后死亡。本病例描述了多器官整块移植后以单纯全血细胞减少为表现的GVHD实例。GVHD是实体器官移植中一种罕见但严重的并发症，可导致死亡。虽然单纯骨髓受累不常见，但必须尽早考虑，以免延误诊断。本病例还凸显了GVHD与多器官移植的关联，尽管目前文献对此的描述并不完整。
