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Fatal Graft-Versus-Host Disease Presenting as Fever of Unknown Origin in a Pancreas-After-Kidney Transplant Recipient
Article first published online: 19 FEB 2008
DOI: 10.1111/j.1600-6143.2008.02150.x
2008 The Authors Journal compilation © 2008 The American Society of Transplantation and the American Society of Transplant Surgeons
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How to Cite
Weng, F. L., Pancoska, C. and Patel, A. M. (2008), Fatal Graft-Versus-Host Disease Presenting as Fever of Unknown Origin in a Pancreas-After-Kidney Transplant Recipient. American Journal of Transplantation, 8: 881–883. doi: 10.1111/j.1600-6143.2008.02150.x
Publication History
- Issue published online: 19 FEB 2008
- Article first published online: 19 FEB 2008
- Received 23 August 2007, revised 03 December 2007 and accepted for publication 27 December 2007
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Keywords:
- Fever;
- graft-versus-host disease (GVHD);
- pancreas after kidney;
- pancreas transplantation;
- short tandem repeats
A recipient of a pancreas-after-kidney transplant developed fatal acute graft-versus-host disease that initially manifested as fevers of unknown origin.
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.