Graft versus host disease in spleen- inclusive multi-visceral transplantation

摘要

The spleen is usually removed from a multi-visceral graft before implantation in the recipient. However, the asplenic state potentially causes long-term impairment of humoral and cellular immunity. We report the first spleen-inclusive adult multi-visceral transplant in the UK. A 38 year-old male with severe visceral myopathy underwent a spleen-inclusive modified multi-visceral transplantation. Immunosuppression was induced by Alemtuzumab (Campath 1H) and maintained with Tacrolimus. One month later, he developed an erythematous skin rash on his chest and hands. Investigations revealed peripheral donor T cell chimerism and skin biopsy showed the presence of donor cells. The patient was treated with high dose methyl prednisolone and Alemtuzumab. He made a complete recovery from Graft versus host disease (GVHD). At 22 months follow-up, the patient had no any evidence of rejection or recurrence of GVHD.