Hematologic Disorders after Solid Organ Transplantation

Abstract

The evaluation of hematologic disorders after solid organ transplantation (SOT) must take into account issues unique to the post-transplant setting that influence the development of anemia and single or multi-lineage cytopenias. Attention to the time of onset of cytopenia(s) is important, because the disorders of passenger lymphocyte syndrome, transplant-related thrombotic microangiopathy, hemophagocytic syndrome, and graft-versus-host disease typically occur during the first few months after SOT, and post-transplant lymphoproliferative disorder usually occurs within the first year. Drug-related anemia and cytopenia(s) occur due to a variety of mechanisms, including drug-induced hemolysis and marrow suppression and perturbation of T-cell subsets by the immunosuppressive agents, leading to immune dysregulation and autoimmunity. Viral infections can cause direct suppression of hematopoiesis, and a variety of opportunistic infections can precipitate acquired hemophagocytic syndrome, a frequently lethal systemic inflammatory disorder. Early investigation of pancytopenia by bone marrow biopsy is warranted, because it is often the presenting symptom of one or multiple life-threatening pathologies after SOT, such as graft-versus host disease, post-transplant lymphoproliferative disorder, hemophagocytic syndrome, or severe opportunistic infections, and these entities may have a better prognosis if early interventions are undertaken.

Solid-Organ Graft-Versus-Host Disease After Liver Transplant: A Case Report

“…2 Published incidence rates for SOT-GVHD in liver transplant recipients are between 0.1% and 2%. 2,4 Mortality rates are documented at 75% or greater in liver transplant recipients. 3,5 There are 2 forms of SOT-GVHD.…”

“…Next, donor-origin effector cells produce an immunological attack against immunologically disparate host tissue. 2 SOT-GVHD has an acute phase and a chronic phase. The acute phase is defi ned as occurring within the fi rst 100 days after transplant.…”

“…11 Diagnosis of SOT-GVHD is implied by biopsy-proven histologic features. 2 Confi rmation is made by showing greater than 1% 12 lymphocyte macrochimerism in peripheral blood. 2 Of note, diagnosis of SOT-GVHD is commonly delayed as the early signs and symptoms mirror those of more common problems such as viral illnesses.…”

“…2 Confi rmation is made by showing greater than 1% 12 lymphocyte macrochimerism in peripheral blood. 2 Of note, diagnosis of SOT-GVHD is commonly delayed as the early signs and symptoms mirror those of more common problems such as viral illnesses. Donor chimerism studies should be obtained and GVHD diagnosis should be considered in all solid-organ transplant recipients with rash, diarrhea, liver dysfunction, and/or pancytopenias.…”

“…Other risk factors include greater HLA match between donor and recipient 3 and age greater than 65 years. 2,4 SOT-GVHD typically is manifested by fever, diarrhea, rash, and multilineage cytopenia or pancytopenia. 2 The signs and symptoms are usually quite subtle 6 and are often confused with early infection in the immunocompromised state.…”