Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

• Published in: The New England journal of medicine Vol. 358; no. 4; pp. 369 - 374
• Main Authors: Alexander, Stephen I, Smith, Neil, Smith, Arabella, Hu, Min, Verran, Deborah, Shun, Albert, Dorney, Stuart, Webster, Boyd, Shaw, Peter John, Lammi, Ahti, Stormon, Michael O
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 24.01.2008
• Subjects: Biological and medical sciences; Child; Female; General aspects; Graft vs Host Disease; Hemolysis - immunology; Humans; Immunosuppression; Liver Failure, Acute - surgery; Liver Transplantation - immunology; Medical sciences; T-Lymphocytes - immunology; Transplantation Chimera - immunology; Transplantation Tolerance - genetics; Transplantation Tolerance - immunology; Transplantation, Homologous; Human; Medicine; Treatment; Donor; Surgery; Liver; Tolerance; Graft; Recipient; Transplantation; Chimerism; Cadaver
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0707255

Complete hematopoietic chimerism and tolerance to a liver allograft developed in a 9-year-old girl who received a liver transplant from a deceased male donor. Tolerance was preceded by a period of severe hemolysis, reflecting partial chimerism that was refractory to standard therapies. The hemolysis resolved after the gradual withdrawal of all immunosuppressive therapy. Complete hematopoietic chimerism and tolerance to a liver allograft developed in a 9-year-old girl who received a liver transplant from a deceased male donor. Tolerance was preceded by a period of severe hemolysis, which resolved after the gradual withdrawal of all immunosuppressive therapy. Case Report Acute fulminant hepatitis after a nonspecific viral illness developed in a previously well 9-year-old girl. Her blood group was O, RhD-negative. She was referred to our institution, and at the time of admission she had markedly elevated aminotransferase levels and evidence of marked synthetic dysfunction (Table 1). Extensive testing ruled out known viral, metabolic, drug-related, and autoimmune causes, and a diagnosis of “non–A-to-G viral hepatitis” was made. A liver biopsy was not performed because of severe underlying coagulopathy. Given the patient's fulminant hepatic failure (Table 1) requiring mechanical ventilation, urgent liver transplantation was performed with the use of . . .