Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

Abstract

Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The tolerance was preceded by a period of severe hemolysis, reflecting partial chimerism that was refractory to standard therapies. The hemolysis resolved after the gradual withdrawal of all immunosuppressive therapy.

Hematopoietic chimerism in liver transplantation patients and hematopoietic stem/progenitor cells in adult human liver

“…1 Similar to other types of organ transplantation, chimerism can develop after LT with the chimeric cells either circulating or integrated into the parenchyma. 2 Several types of reciprocal chimerisms after LT have been reported, including (1) recipient-derived cells in the donor organ 3,4 ; (2) hematopoietic chimerism of donor origin in the recipient blood [5][6][7] ; and (3) donor origin cells in the skin and lymph nodes. 8 Donor lymphocyte chimerism is common after LT, but it usually decreases and often disappears within 3 weeks.…”

Naturally acquired tolerance and sensitization to minor histocompatibility antigens in healthy family members

“…The tolerogenic potential of chimerism, established either through bone marrow transplantation (macrochimerism) 12 or through pregnancy (microchimerism), 7 has been documented in both rodent 13,14 and in human transplantation settings. 15,16 We earlier described the presence of minor H antigen HA-1-specific T CTL , minor H antigen HA-1-specific T REG , and HA-1 ϩ circulating microchimeric cells in the setting of kidney transplantation. 17 The latter cell populations were observed in a long-term tolerant HA-1 Ϫ patient transplanted with a renal allograft from her HLA identical HA-1 ϩ sister.…”

Immunosuppressive Therapy and Tolerance of Organ Allografts

“…1 ,2 The third report, by Alexander et aI., concerns a young girl who received a completely HLA-mismatched liver from a deceased male donor but did not receive a donor stem-cell infusion. 3 The cause of the fulminant hepatic failure with which the patient presented was never firmly established. However, a viral infection was thought to have caused lymphopenia that was noted at the initial hospital admission and persisted for a half year after liver transplantation.…”

“…2 The authors conclude that cost sharing should be waived for mammography, essentially because mammography is beneficial, and therefore reducing its use by imposing out-oE-pocket costs is against the interest of public health. 3 Their conclusion raises a challenging health policy question: How, if at all, should cost sharing be incorporated into the design of health insurance? Specifically, what is the best way to structure financial incentives so that patients use health care services wisely but not excessively -or, in colloquial terms, what kind of "skin in the game" best serves the interest of patients within the fiscal constraints of the health care system?4…”