Treatment of Acute Graft-vs-Host Disease After Simultaneous Pancreas-Kidney Transplantation: A Case Report

• Published in: Transplantation proceedings Vol. 42; no. 9; pp. 3894 - 3897
• Main Authors: Osband, A.J, Laskow, D.A, Mann, R.A
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01-11-2010; Elsevier
• Subjects: Acute Disease; Adolescent; Biological and medical sciences; Bone Marrow Examination; Drug Therapy, Combination; Fatal Outcome; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft vs Host Disease - diagnosis; Graft vs Host Disease - drug therapy; Graft vs Host Disease - etiology; Humans; Immunosuppressive Agents - therapeutic use; Karyotyping; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Pancreas Transplantation - adverse effects; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Treatment Outcome; Human; Immunopathology; Graft versus host disease; Acute; Concurrent; Transplantation; Homotransplantation; Kidney; Case study; Medicine; Treatment; Urinary system; Combined surgery; Graft; Pancreas
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.08.058

Abstract Whereas neutropenia is common after solid-organ transplantation, graft-vs-host disease is unusual, especially after simultaneous pancreas-kidney transplantation. Most cases reported in the literature give few details of treatment approach, and all were fatal. A 45-year-old man with diabetes underwent simultaneous pancreas-kidney transplantation at our center, with organs from a female donor. Two weeks postoperatively, he was readmitted with fever, malaise, and neutropenia. A bone marrow biopsy specimen demonstrated that two-thirds of the lymphocytes were of female karyotype. Graft-vs-host disease was diagnosed. Aggressive immunosuppression therapy was administered; however, the patient died. To our knowledge, this is the first case report with specific details of a treatment protocol and sequential short tandem repeat data.