FISH diagnosis of acute graft-versus-host disease following living-related liver transplant.
Acute graft-versus-host disease (GVHD) is an uncommon but often fatal complication following liver transplant. We describe a GVHD case in which a female patient with primary biliary cirrhosis underwent a living-related liver transplant from her son. The human leukocyte antigen typing of the donor was homozygous at all loci. The recipient's human leukocyte antigen type was haplo-identical to that of the donor. A bone marrow aspirate performed for pancytopenia revealed a severely hypoplastic marrow. Fluorescent in situ hybridization (FISH) using X- and Y-chromosome probes demonstrated that 80% of marrow cells were of donor origin. Comparison of Giemsa-stained cell morphology and FISH showed that the erythroid precursor cells were predominantly of male pattern (XY). This report is one of only a few studies that prove the migration of a donor's hematopoietic stem cells to a recipient's bone marrow. We demonstrated that FISH analysis using sex chromosome probes is useful to confirm a diagnosis of GVHD following organ transplantation from a donor of the opposite sex. We also showed that donor hematopoietic stem cells in a liver graft can migrate to the recipient's bone marrow. We suggest that FISH is a rapid and reliable test for confirming the diagnosis of GVHD in a peripheral blood or skin biopsy sample.
Kanehira
Kazunori
K
Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Riegert-Johnson
Douglas L
DL
Chen
Dong
D
Gibson
Lawrence E
LE
Grinnell
Stephen D
SD
Velgaleti
Gopalrao V
GV
D001854:Bone Marrow Cells / Q000276:immunology; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D006680:HLA Antigens