Acute Graft-Versus-Host-Disease in Kidney Transplantation: Case Report and Review of Literature

• Published in: Transplantation proceedings Vol. 41; no. 9; pp. 3949 - 3952
• Main Authors: Kato, T, Yazawa, K, Madono, K, Saito, J, Hosomi, M, Itoh, K
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2009; Elsevier
• Subjects: Acute Disease; Adult; Anemia, Hemolytic - diagnosis; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft vs Host Disease - drug therapy; HLA Antigens - analysis; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Male; Medical sciences; Methylprednisolone Hemisuccinate - therapeutic use; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Pancreas Transplantation - adverse effects; Reoperation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Outcome; Human; Immunopathology; Graft versus host disease; Acute; Stem cell; Hematopoietic cell; Homograft; Homotransplantation; Kidney; Case study; Medicine; Treatment; Urinary system; Surgery; Graft; Bibliographic review; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.05.030

Abstract Graft-versus-host-disease (GVHD) is a complication of solid organ transplantation, most commonly of the small bowel or liver. Herein, we have presented a case of GVHD in a 27-year-old man who underwent an human leukocyte antigen (HLA) minor mismatch renal transplantation from his father. After the procedure, the patient presented with a fever, skin rash, and watery diarrhea. An allograft kidney biopsy demonstrated no sign of rejection; however, anti-A antibody was detected in plasma and progressive anemia was attributed to hemolytic anemia owing to a passenger lymphocyte syndrome. From those findings, we suspected that the clinical symptoms were caused by acute GVHD. An endoscopic biopsy of the colon revealed apoptotic cells consistent with the disease. We found reports of only 5 other GVHD cases after kidney transplantation. Several risk factors are associated with GVHD, such as transfer of graft lymphocytes, donor HLA homozygosity, and a relationship between recipient immunogenicity and immunosuppression. In this case, detection led to early diagnosis of donor-derived GVHD due to passenger lymphocyte syndrome. It is important keep GVHD in mind and to understand its risk factors as the mortality rate is high.