NEUTROPHILS AND LYMPHOID CHIMERISM AFTER ADULT LIVING-RELATED LIVER TRANSPLANTATION FROM A HOMOZYGOUS DONOR.

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NEUTROPHILS AND LYMPHOID CHIMERISM AFTER ADULT LIVING-RELATED LIVER TRANSPLANTATION FROM A HOMOZYGOUS DONOR.
Ali H. Hajeer, PhD, MRCPath , Samir Issa MD , Khalid Abdullah MD , Mohammed Awad PhD , Abdelghani Tbakhi MD, FCAP , Ahmad Askar MD and Abdulmajeed Abdulkareem MD . Riyadh Saudi Arabia, King Fahad National Guard Hospital, 11426, Pathology ; Riyadh Saudi Arabia, King Fahad National Guard Hospital, 11426, Hepatobiliary Sciences and Riyadh Saudi Arabia, King Faisal Specialist Hospital & Research Centre, Immunopathology .

Graft-versus host disease (GVHD) is a significant risk in liver transplant patients. The risk is even higher in cases of living-related liver transplant (LRLT). Donors homozygous at all HLA loci carry higher risk for GVHD. Here we present a case of LRLT, the recipient suffered from end stage liver disease and received a right lobe graft from his son. Eight months after the transplant, the patient developed profound bone marrow suppression. The patient was negative for CMV, Brucella, HHV6, HHV8, HBV, HCV and Parvovirus. No sign of GVHD was noted (skin and GI). The patient and donor were HLA typed by SSP. The donor was homozygous for all HLA loci while the patient shared the class II homozygosity and was heterozygous at the class I. Chimerism studies were prompted after noting that the neutrophils compartment of the patient were homozygous at all HLA loci. This initiated further studies of the PMN and lymphocytes by microsatellite analysis. A total of 15 microsatellites were analyzed. Results suggested that majority (75%) of the PMN cells and 45% of the lymphocytes were of donor origin. The patient was treated with G-CSF and his WBC counts returned to normal levels. Two and a half years post transplant and the patient did not develop GVHD, despite the high number of donor lymphocytes circulating in his blood stream. The only complaint he has now is the development of severe arthritis, which was treated with steroids. Whether this is a result of the GVHD or not, this is to be investigated.