ANTI-HLA ANTIBODIES VERSUS GRAFT VERSUS HOST DISEASE IN A LIVER TRANSPLANT
PATIENT.
C Johnson, P Terasaki, R Busuttil, M Cecka. UCLA Tissue Typing
Lab, Los Angeles, Ca.
Graft versus host disease is increasingly being recognized
during the first month after liver transplantation. Establishing the diagnosis
of GVHD is difficult as the clinical and pathologic features are indistinct.
However, we have shown that detection and quantitation of chimerism in
recipient tissues are possible by Flow Cytometry enabling an early diagnosis
of GVHD and rapid evaluation of the success of treatment. We present here
a case of GVHD following liver transplantation of patient JW whose HLA
type was 1, 2, 8, 27 DR 8, 17. She received a liver transplant from
a donor with HLA type of 1, 32, 8, 44 DR 8, 12. Approximately one month
posttransplant JW presented with a chimeric HLA type of 1, 2, 32, 8, 27,
44, DR, 8, 17, 12 as determined by cytotoxicity. The recipient's
HLA specificities were weak when compared to the stronger reactions of
the donor HLA. JW was treated with plasma transfusions from a donor who
had anti-B44. Treatment with this alloantibody was suggested to be preferable
to antibodies such as OKT3, since it would kill the donor cells but not
the recipient's cells. The plasma treatment was followed by analyzing the
percentage of HLA A2 positive T cells using Flow Cytometry and an allo-A2
antibody. The percentage of HLA A2 positive cells was determined before
the plasma transfusion, at 4 and at 29 hours after plasma transfusion with
results of 5%, 6% and 40% HLA A2 positive cells, respectively. This increase
in the recipient's cells gave some indication that the donor lymphocytes
were being affected whereas the recipient cells were not. The treatment
could be closely monitored this way with almost immediate results to evaluate
its success. Although patient JW died, the results suggest that anti-donor
mismatched HLA antibody can be used to remove circulating donor lymphocytes
without harming the patient or the graft.