Kidney Week

Abstract: TH-PO592

Graft-versus-Host Disease After Kidney Transplant

Session Information

• Trainee Case Reports - II
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

• 1802 Transplantation: Clinical

Authors

• Sanchez vazquez, Omar Humberto, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Omar Humberto Sanchez vazquez,

• Parra Michel, Renato, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Renato Parra Michel,

• Cisneros-Carbajal, Marlene Del rocio, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Marlene Del rocio Cisneros-Carbajal,

• Murga, Antonio Mariano, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Antonio Mariano Murga,

• Fuentes Ramirez, Francisco, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Francisco Fuentes Ramirez,

• Molgado castillo, Ana Margarita, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Hospital General Regional No.46, Instituto Mexicano del Seguro Social, Guadalajara, jalisco, Mexico

Ana Margarita Molgado castillo,

Introduction

Graft-versus-host disease is an uncommon complication after solid organ transplantation. Few cases of graft-versus-host disease after kidney transplantation have been reported.

Case Description

A 32-year-old man was admitted to our hospital in August 2017 due to cellulitis of the right leg. He received ceftriaxone and clindamycin.
His past medical history included end-stage renal failure at the age of 19 years old. It was necessary to start peritoneal dialysis until he received a renal transplant in 2007 from a related donor (his father, 41-years-old at the time), he had matching HLA (A, B and DR) antigens.
The recipient received induction therapy with rabbit-antithymocyte globulin and a triple immunosuppressive regimen.
In February 2018 he developed bullous lesions burning pain on the back of the left leg. Skin lesions then coalesced and became hemorrhagic, spreading to the rest of the leg and thigh. They eventually turned into crusts in a month. A Dermatology evaluation was requested, and a skin biopsy was performed. Biopsy reported: epidermal acanthosis and mild spongiosis of the basal layer; upper dermis showed blood vessels with lymphocytic infiltrate (without vasculitis). There was proliferation, thickening and homogenization of collagen tissue fibers and deep perifollicular fibrosis with a suggestive diagnosis of sclerodermiform dermatosis chronic variant of graft-versus-host disease.

Discussion

The main risk factors include donor HLA homozygosity, peri-organ lymphoid tissue transfer and the relationship between recipient immunogenicity and the immunosuppressive drug regimen.
Diagnosis is made by specific tests which detect macrochimerism, single-tandem repeat and DNA analysis which quantifies relative amounts of different DNA.