Funding sources: No outstanding funding was required for this manuscript.
Absence of peripheral blood chimerism in graft-vs-host disease following orthotopic liver transplantation: case report and review of the literature
Article first published online: 30 DEC 2013
© 2013 The International Society of Dermatology
International Journal of Dermatology
Volume 53, Issue 11, pages e492–e498, November 2014
How to Cite
Schulman, J. M., Yoon, C., Schwarz, J., Vagefi, P. A., Mully, T. W. and Shinkai, K. (2014), Absence of peripheral blood chimerism in graft-vs-host disease following orthotopic liver transplantation: case report and review of the literature. International Journal of Dermatology, 53: e492–e498. doi: 10.1111/ijd.12149
Disclosure/Conflicts statement: There are no commercial products discussed in this manuscript, and the authors do not have relevant financial conflicts of interest to disclose.
- Issue published online: 20 OCT 2014
- Article first published online: 30 DEC 2013
Graft-vs-host disease (GVHD) is a rare and often fatal complication of orthotopic liver transplantation (OLT). The skin is frequently involved early in disease progression, but clinical and histopathological features may be nonspecific, presenting a diagnostic challenge. While the detection of peripheral blood chimerism has been proposed as a diagnostic criterion for post-OLT GVHD, it is not known whether peripheral blood chimerism is an absolute requirement for the diagnosis.
Materials and methods
We report a case of a 57-year-old man who developed post-OLT GVHD with cutaneous, enteric, and bone marrow involvement. We also review the epidemiology, pathogenesis, clinical presentation, histopathology, molecular diagnostic techniques, and treatment of GVHD following liver transplantation.
In our patient, analysis of the peripheral blood by short-tandem repeat polymerase chain reaction did not detect circulating donor lymphocytes. Donor lymphocytes were detected in the buccal mucosa, however, confirming the diagnosis. A review of chimerism patterns in 63 previously published cases of post-OLT GVHD reveals that this is the first reported case in which chimerism was absent in the peripheral blood but present in another site.
Peripheral blood chimerism may be absent in cases of post-OLT GVHD. A combination of clinical, histopathological, and molecular features is therefore required to make this challenging diagnosis.