Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis

Marilyn S. Pollack, Kermit V. Speeg, Natalie S. Callander, Cesar O. Freytes, Alfredo A. Espinoza, Robert M Esterl, Gregory A. Abrahamian, William K Washburn, Glenn A. Halff

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


A 52-year-old liver transplant recipient presented 8 months after transplantation with oral thrush, then 3 days later with oral ulcers and a diffuse rash, and 5 days later with an acutely reduced white blood cell count, rash, fever, and diarrhea. Bone marrow biopsy revealed severe aplasia. Although graft-versus-host disease (GVHD) was considered, the late onset of these symptoms was felt to render this etiology unlikely because GVHD usually occurs 2 to 6 weeks after transplantation. All potentially myelosuppressive medications were discontinued, and the patient was treated with high doses of hematopoietic growth factors. Because his symptoms continued, chimerism analysis was performed, which indicated that 96% of the peripheral blood mononuclear cells were of liver-donor origin. Ultimately, the patient underwent an allogeneic peripheral blood hematopoietic progenitor cell transplant from a human leukocyte antigen-identical brother, but he died 5 days after transplantation of overwhelming Candida kruseii infection. To our knowledge, this is the first chimerism-analysis-documented case of severe acute GVHD presenting so late after liver transplantation. It is of note that the patient had no known risks for GVHD in that he was relatively young and shared only one major human leukocyte antigen with his donor. Consideration should be given to GVHD as a cause of bone marrow aplasia at any time after organ transplantation. Storage of cell pellets from all transplant recipients and donors is highly recommended to facilitate the diagnostic evaluation.

Original languageEnglish (US)
Pages (from-to)28-31
Number of pages4
JournalHuman Immunology
Issue number1
StatePublished - Jan 2005


  • HLA
  • chimerism analysis
  • graft versus host disease
  • liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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