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Transient posttransplant graft-versus-host lymphadenopathy
Laurentia Nodit1, Noriko Murase, Jorge D Reyes
1Department of Pathology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
Summary
Graft-versus-host (GVH) lymphadenopathy in a pediatric transplant patient presented as a self-limiting reaction. Lymphocyte trafficking between graft and host resolved without significant tissue damage, leading to recovery with reduced immunosuppression.
Area of Science:
- Pediatric transplantation
- Immunology
- Gastroenterology
Background:
- Graft-versus-host disease (GVHD) is a rare complication following solid organ transplantation.
- Information on GVHD-like lymphadenopathy in humans is limited.
- A pediatric patient underwent liver and small bowel transplantation for short bowel syndrome.
Observation:
- The patient developed a GVHD-like skin rash and later diffuse lymphadenopathy.
- Lymph node biopsy revealed effaced architecture with immunoblasts, T-cells, and dendritic cell hyperplasia.
- Viral studies were negative for common pathogens.
Findings:
- Flow cytometry showed circulating donor cells.
- The observed reaction was characterized by lymphocyte trafficking and in situ mixed lymphocyte reaction.
- The condition was self-limiting, with lymphadenopathy resolving and circulating donor cells decreasing.
Implications:
- This case suggests a GVH-type reaction without significant tissue damage can occur in pediatric solid organ transplantation.
- Management involved a decrease in immunosuppression, leading to a favorable outcome.
- Understanding this reaction is crucial for managing post-transplant complications.