Transient Posttransplant Graft-versus-Host Lymphadenopathy

There is sparse information in humans on graft-versushost (GVH) lymphadenopathy. A 15-month-old male received a liver and small bowel transplant for short bowel after gastroschisis. At 21 days he developed a GVH-like skin rash. Flow cytometry demonstrated 16.1% circulating donor cells. Polymerase chain reaction for Epstein-Barr virus was negative. Two months later, the rash recurred with diffuse lymphadenopathy. Lymph node biopsy showed effaced architecture without visible follicles, large numbers of CD79a+ immunoblasts interspersed with smaller CD3+ and CD8+ cells, and prominent dendritic cell hyperplasia. Human herpes virus 8, cytomegalovirus, and EBER-1 probes were negative, as was polymerase chain reaction for human herpes virus 6. Allograft intestinal biopsies on days 10 and 24 had a similar infiltrate. The features appeared to be those of lymphocytes trafficking between the graft and host with a mixed lymphocyte reaction in situ, a GVH-type reaction without tissue damage. The reaction was self-limiting in the intestinal graft, and the lymphadenopathy resolved with some decrease in immunosupression. Circulating donor cells fell to 2.5% by day 62, and the child has been rejection free on low-dose immunosuppression.