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Lung transplantation complicated by graft-versus-host disease and confounded by incidental transfusion-associated macrochimerism

Authors

  • Katerina Pavenski,

    1. From the Department of Medicine, McMaster University, and the Canadian Blood Services, Hamilton, Ontario; and Laboratory Genetics, Department of Pathology, and Departments of Laboratory Hematology (LMP) & Clinical Hematology (Medicine), The University Health Network, Toronto, Ontario, Canada.
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  • Suzanne Kamel-Reid,

    1. From the Department of Medicine, McMaster University, and the Canadian Blood Services, Hamilton, Ontario; and Laboratory Genetics, Department of Pathology, and Departments of Laboratory Hematology (LMP) & Clinical Hematology (Medicine), The University Health Network, Toronto, Ontario, Canada.
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  • Cuihong Wei,

    1. From the Department of Medicine, McMaster University, and the Canadian Blood Services, Hamilton, Ontario; and Laboratory Genetics, Department of Pathology, and Departments of Laboratory Hematology (LMP) & Clinical Hematology (Medicine), The University Health Network, Toronto, Ontario, Canada.
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  • Christine M. Cserti-Gazdewich

    1. From the Department of Medicine, McMaster University, and the Canadian Blood Services, Hamilton, Ontario; and Laboratory Genetics, Department of Pathology, and Departments of Laboratory Hematology (LMP) & Clinical Hematology (Medicine), The University Health Network, Toronto, Ontario, Canada.
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Katerina Pavenski, 1200 Main Street West, Room HSC 3N43, Hamilton, Ontario, Canada L8N 3Z5; e-mail: pavensk@mcmaster.ca.

Abstract

BACKGROUND: Passenger lymphocyte–mediated graft-versus-host disease (GVHD) in solid organ transplantation (SOT-GVHD) is considered a rare complication, particularly among recipients of lung allografts. The risk of transfusion-associated GVHD (TA-GVHD) in solid organ transplants is also considered rare. The suspicion of either may be heralded by signs and symptoms of GVHD in the company of a population of passenger lymphocytes in excess of 1 percent (microchimerism). This case report illustrates the challenge of a patient who presented with macrochimerism both from the lung transplant allograft and from transfusions.

STUDY DESIGN AND METHODS: Chimerism assessments of the pre- and posttransplant donor lung, and the recipient's aplastic marrow, were made using DNA-based polymerase chain reaction testing.

RESULTS: Macrochimerism was observed in both the posttransplant aplastic host marrow and the engrafted donor lung, with the former predominantly consisting of lung donor lymphocytes and the latter a mixture of lung and presumably transfusion source donor lymphocytes. The pretransplant donor lung exhibited no GVHD-like pathology.

CONCLUSION: This case demonstrates SOT-GVHD, with the unusual feature of concomitant macrochimerism from transfusions. SOT-GVHD likely predisposed this patient to the observed transfusion-associated macrochimerism. However, the dissociation between transfusion-attributable macrochimerism and attributable pathology is intriguing. Furthermore, the risk spectrum of transfusion-associated macrochimerism and TA-GVHD in solid organ transplant recipients with and without the complication of SOT-GVHD is unknown and warrants further study.

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