Acute Graft Versus Host Disease After Kidney-Pancreas Transplant

Abstract

Acute graft vs. host disease (aGVHD) results from newly transplanted donor immune cells recognizing recipient tissues as foreign, leading to end-organ damage. Diagnosing aGVHD typically involves a combination of clinical evaluation, histological examination, laboratory tests, and imaging studies. Although typically associated with allogeneic stem cells transplant and less frequently with liver or small bowel transplants, solid organ transplant GVHD (SOT-GVHD) associated with kidney-pancreas transplants is exceedingly rare. Our patient presented with pancytopenia unexplained by typical causes. He developed classical aGVHD findings of fever, diarrhea, rash, and abnormal liver tests. Our case underscores the importance of keeping a broad differential when evaluating solid organ transplant patients.

Keywords: acute graft vs host disease; graft; solid organ transplant; transplant; unexplained shock.

Figure 1. Bone marrow core showing low cellularity for age.

Panhypoplasia and presence of dispersed erythropoietic elements and megakaryocytes. Scattered macrophages with hemosiderin are noticed.

Figure 2. Example of patient’s rash from the posterior left arm.

Figure 3. Skin biopsy showing mild hyperkeratosis, mild acanthosis, discrete spongiosis, and multiple necrotic keratinocytes dispersed on all layers of the epidermis.