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Volume 6
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Case Report

Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient

by
Reza Rahimi Shahmirzadi
1,*,
Danielle Ouellette
1,
Martin Igbokwe
2,
Alp Sener
1,
Manal Y. Gabril
3,
Subrata Chakrabarti
3,
Uday Deotare
4 and
Lili Ataie
5
1
Division of Infectious Diseases, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
2
Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
3
Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
4
Division of Hematology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
5
Division of Dermatology, Department of Internal Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
*
Author to whom correspondence should be addressed.
Transplantology 2025, 6(3), 24; https://doi.org/10.3390/transplantology6030024
Submission received: 13 June 2025 / Revised: 30 July 2025 / Accepted: 4 August 2025 / Published: 12 August 2025
(This article belongs to the Section Transplant Immunology and Immunosuppressive Drugs)
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Abstract

Background: Graft-versus-host disease (GVHD) is a rare but serious complication following solid organ transplantation (SOT), particularly in transplants involving organs with a high volume of passenger donor T-lymphocytes. This case highlights the clinical course and diagnostic challenges of GVHD following simultaneous pancreas and pre-emptive kidney transplantation. Methods: A 51-year-old male with long-standing type 1 diabetes mellitus underwent simultaneous pancreas and kidney transplantation with induction therapy using rabbit anti-thymocyte globulin and methylprednisolone. Three months post-transplant, he presented with a diffuse lichenoid cutaneous eruption. Diagnostic evaluation included an extensive infectious workup, skin punch biopsy, liver and bone marrow biopsies, and microchimerism assay. Results: Skin biopsy revealed interface vacuolar dermatitis consistent with cutaneous GVHD. Subsequent liver and bone marrow biopsies confirmed GVHD involvement, with microchimerism assay showing 43% donor-origin T-cells in the bone marrow. Initial treatment with systemic and topical corticosteroids led to temporary improvement. However, the patient developed bone marrow suppression, recurrent bacteremia, and invasive fungal infection, resulting in a prolonged ICU stay and ultimately death. Conclusions: This case underscores the importance of considering SOT-GVHD in patients receiving organs rich in donor lymphocytes, such as pancreas transplants. Early recognition and multidisciplinary management are critical to improving outcomes in this rare but life-threatening condition.
Keywords: graft-versus-host disease; solid organ transplantation; fluorescence in situ hybridization; chimerism assays graft-versus-host disease; solid organ transplantation; fluorescence in situ hybridization; chimerism assays

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MDPI and ACS Style

Rahimi Shahmirzadi, R.; Ouellette, D.; Igbokwe, M.; Sener, A.; Gabril, M.Y.; Chakrabarti, S.; Deotare, U.; Ataie, L. Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient. Transplantology 2025, 6, 24. https://doi.org/10.3390/transplantology6030024

AMA Style

Rahimi Shahmirzadi R, Ouellette D, Igbokwe M, Sener A, Gabril MY, Chakrabarti S, Deotare U, Ataie L. Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient. Transplantology. 2025; 6(3):24. https://doi.org/10.3390/transplantology6030024

Chicago/Turabian Style

Rahimi Shahmirzadi, Reza, Danielle Ouellette, Martin Igbokwe, Alp Sener, Manal Y. Gabril, Subrata Chakrabarti, Uday Deotare, and Lili Ataie. 2025. "Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient" Transplantology 6, no. 3: 24. https://doi.org/10.3390/transplantology6030024

APA Style

Rahimi Shahmirzadi, R., Ouellette, D., Igbokwe, M., Sener, A., Gabril, M. Y., Chakrabarti, S., Deotare, U., & Ataie, L. (2025). Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient. Transplantology, 6(3), 24. https://doi.org/10.3390/transplantology6030024

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