輸血によりＧＶＨＤ（移植片対宿主病）をきたした維持透析患者の１例

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  • Transfusion-associated graft-versus-host disease(GVHD) in a dialysis patient.

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Graft-versus-host disease (GVHD) developed in a dialysis patient who had received blood transfusions of approximately 2 units (1 unit=200ml) a month for years since he entered dialysis therapy. Clinical features of the GVHD included the development of fever, diarrhea, liver dysfunction, pancytopenia, and finally fatal respiratory failure. The diagnosis of GVHD was confirmed by bone marrow biopsy, skin biopsy, and HLA typing. The bone marrow showed marked hypocellularity. Histological examination of the skin revealed vacuolar degeneration and the infiltration of CD 8 positive lymphocytes in the basal cell layer. The parental haplotypes were speculated from the HLA typing of the siblings. However, the HLA phenotype of the patient was incompatible with the parental ones. The patient's therapy was commensed on the combination therapy of murine monoclonal antihuman T cell antibody (OKT 3), methylprednisolone pulse therapy, and granulocyte colony stimulating factor (G-CSF). Immediately following this treatment, the numbers of granulocytes and platelets in the peripheral blood were found to have markedly increased, but two weeks after the treatment, the patient died of cytomegalovirus pneumonia.<br>Transfusion-associated GVHD occurs most commonly in immunocompromised patients such as recipients of bone marrow transplantation, but it also develops in patients who have undergone cardiac surgery. However, as far as we know, transfusion-associated GVHD in a dialysis patient has not been described previously. This case may provide further information when considering blood transfusion in dialysis patients.

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