GRAFT VERSUS HOST DISEASE IN A RENAL TRANSPLANT RECIPIENT DUE TO A POST-TRANSPLANT BLOOD TRANSFUSION.

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GRAFT VERSUS HOST DISEASE IN A RENAL TRANSPLANT RECIPIENT DUE TO A POST-TRANSPLANT BLOOD TRANSFUSION.
Marilyn S. Pollack PhD ¹ and Mazen Y. Arar MD ¹. ¹ Departments of Pathology (MSP) and Pediatrics (MYA), University of Texas Health Science Center, San Antonio, TX, USA .

Graft versus host disease (GvHD) is a common occurrence after hematopoietic stem cell transplant as a result of the deliberate infusion of large numbers of immunocompetent donor cells. It is also not a rare event after liver or small intestine solid organ transplant but has only very rarely been reported after kidney transplantation; kidneys are generally very well perfused before transplant and very few donor lymphocytes would be expected to remain within the kidney tissue. We were therefore very surprised to learn that one of our pediatric kidney transplant recipients had significant numbers of skin lesions shortly after his transplant and that biopsies of several of those lesions were determined to be consistent with GvHD by a pathologist with considerable experience in making that differential diagnosis. Interestingly, analysis of informative STR systems that distinguished the kidney recipient and donor indicated that extra sets of bands were present in the biopsy material that were not derived from the recipient but that were definitely NOT derived from the kidney donor. We then realized that the patient had received blood transfusions from several different donors shortly after his transplant and that the transfused blood had been leukocyte depleted but not irradiated. We can only conclude that one of the blood transfusion donors was the source of the infiltrating lymphocytes. Although this conclusion is only inferred, we feel that it is important to present this study so that others can be aware that there are enough residual lymphocytes present in leukocyte depleted blood to cause GvHD in patients who are very immunosuppressed in the immediate post-renal transplant period.