Objectives: Graft-versus-host disease after solid-organ transplant is exceedingly rare. Although the precise pathogenetic mechanisms are unknown, a progressive increase in donor chimerism is a requirement for its development. The incidence of mixed donor chimerism and its timeline after simultaneous pancreas-kidney transplant is unknown. Materials and Methods: After encountering 2 cases of graft-versus-host disease after simultaneous pancreas-kidney transplant at our institution over a period of < 2 years, a collaborative pilot study was conducted by the bone marrow transplant, nephrology, and abdominal transplant surgery teams. We enrolled all consecutive patients undergoing sex-mismatched simultaneous pancreas-kidney transplant over 1 year and longitudinally monitored donor chimerism using fluorescence in situ hybridization for sex chromosomes. Results: We found no evidence for chimerism in our 7 patients. In a comprehensive literature review, we found a total of 25 previously reported cases of graft-versus-host disease after kidney, pancreas, and simultaneous pancreas-kidney transplants. The median onset of graft-versus-host disease was approximately 5 weeks after transplant, with a median of about 2 weeks of delay between first presentation and diagnosis. Skin, gut, and bone marrow were almost equally affected at initial presentation, and fever of unknown origin occurred in more than half of patients. The median survival measured from the first manifestation of graft-versus-host disease was only 48 days. Conclusions: Within the limitations related to small sample size, our results argue against an unusually high risk of graft-versus-host disease after simultaneous pancreas-kidney transplant. Collaboration between solid-organ and stem cell transplant investigators can be fruitful and can improve our understanding of the complications that are shared between the 2 fields.
Bibliographical noteFunding Information:
From the 1Bone Marrow Transplantation and Leukemia Section, Division of Oncology, the 2Division of Nephrology, the 3Cytogenomics and Molecular Pathology Laboratory, Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, and the 4Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, Missouri, USA Acknowledgements: The authors have no conflicts of interest to declare. The study was partially supported by intramural funding from the Cytogenomics and Molecular Pathology Laboratory, Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO. AR, DCB, and AFC developed the concept and designed the study. AR collected the data, performed the analysis, and wrote the first draft of the manuscript. JRW, IEA, DCB, and AFC critically reviewed the results and the manuscript. The authors thank Sandra Crocker for assistance with sample processing. Current address of A. Rashidi: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Department of Medicine, Minneapolis, MN 55455. Corresponding author: Armin Rashidi, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Department of Medicine, 14-100 PWB, MMC480, 420 Delaware Street SE, Minneapolis, MN 55455, USA Phone: +1 612 301 1894 E-mail: email@example.com
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- Graft-versus-host disease
- Solid-organ transplant