Combined Solid Organ Transplant and Transfusion-Associated Graft-Versus-Host Disease in a Lung Transplant Recipient: An Uncertain Culprit With Lethal Complications.

Although graft-versus-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation, it is rare after solid organ transplantation (SOT) or blood transfusion. We present a rare case of SOT-derived and/or transfusion-associated graft-versus-host disease (TA-GVHD) in a 66-year-old man with interstitial lung disease who underwent bilateral lung transplantation (LT) from a 12-year-old female donor and required three units of packed red blood cells intraoperatively. He presented with signs and symptoms consistent with GVHD, and a bone marrow biopsy revealed an XX karyotype. He died 3 months after bilateral LT, and postmortem chimerism testing using next-generation sequencing identified three sources of DNA within his bone marrow, including the recipient, the lung donor, and a third donor, thereby suggesting the presence of solid organ transplant graft-versus-host disease (SOT-GVHD), TA-GVHD, or a combination of both.