MEDIASTINAL IRRADIATION FOR GRAFT-VERSUS-HOST DISEASE IN A HEART-LUNGTRANSPLANT RECIPIENT

Graft-versus-host disease in solid organ transplantation is very rare, but the prognosis is poor when the condition causes pancytopenia. We report a case of graft-versus-host disease in a heart-lung transplant recipient who at 2 weeks after transplantation had development of feat ures of graft-versus-host disease, including bone marrow aplasia, that could not be attributed to drugs or viral infections. The diagnosis w as confirmed by skin biopsy and demonstration of chimerism of peripher al lymphocytes, Augmentation of immunosuppression with intravenous met hylprednisolone resulted in improvement in liver function but had no e ffect on the pancytopenia. Mediastinal irradiation was given with incr ease in both white blood cell and platelet counts. Unfortunately the p atient eventually died of gastrointestinal bleeding and fungemia.