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.Acute graft-versus-host disease (GVHD) following liver transplantation is a rare complication with a high mortality rate.^1,2 GVHD occurs when immunocompetent donor lymphocytes originating from the transplanted organ undergo activation and clonal expansion, reacting against the recipient antigens. The clinical course begins with fever or skin rash as an early sign, followed by pancytopenia, overwhelming sepsis, and death.³The diagnosis of GVHD is a major challenge and thus the condition often goes unrecognized. Detection of donor lymphocytes in peripheral blood or bone marrow in high-level (>1%) is a key to early detection of GVHD.^1,3