Acute graft-versus-host-disease in kidney transplantation: case report and review of literature

Transplantation Proceedings
T KatoK Itoh

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.

References

Mar 17, 1988·The New England Journal of Medicine·J F BurdickB A Perler
Jul 16, 2003·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·S SudhindranP Gibbs
Aug 17, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·George V MazariegosJorge Reyes
Apr 22, 2006·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Douglas M SmithGoran Klintmalm
Feb 17, 2007·Clinical Transplantation·Maha A AssiRaymund R Razonable

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Citations

Jan 21, 2014·Abdominal Imaging·Olga Rachel BrookBettina Siewert
May 9, 2014·Case Reports in Transplantation·N ZachariasD J Conti
May 5, 2012·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Mouna HamoudaMezri Elmay
Jan 18, 2011·Hematology·Eileen P Smith
Jun 20, 2013·Current Medical Research and Opinion·Chaitanya PantThomas J Sferra
Apr 27, 2013·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·L NadarajahL Green
Sep 16, 2014·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·A P RossiD C Brennan
Jul 1, 2017·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Armin RashidiAmanda Cashen
Nov 9, 2011·Journal of the Korean Surgical Society·Jong Man KimSuk-Koo Lee
May 27, 2010·Special Care in Dentistry : Official Publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry·Renata Gonçalves ResendeRicardo Santiago Gomez
Aug 18, 2012·Blood·Nathaniel TreisterLeslie Lehmann
Jun 3, 2016·Critical Care Nurse·Jonathan S Auerbach, Christopher K Schott
Oct 28, 2017·Transfusion·S Gerald SandlerThomas M Fishbein
Feb 2, 2021·Respiratory Investigation·Masachika HayashiToshiaki Kikuchi
Jul 23, 2021·Transplantation Direct·Stuart S KaufmanCal S Matsumoto

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