Rapid method for the analysis of peripheral chimerism in suspected graft-versus-host disease after liver transplantation

The effects of microchimerism and possible tolerance have been well studied in orthotopic liver transplantation, In some patients, greater levels of d onor cells persist in the periphery. These cells were characterized and the ir effects on clinical outcome were studied. Peripheral blood was obtained from patients at various times posttransplantation. HLA class II typing was performed by the polymerase chain reaction-sequence-specific primer method on unfractionated blood and lymphocyte subpopulations. Relative levels of amplification of donor and recipient alleles were compared. All patients st udied had a low degree of chimerism that was most apparent in the CD8(+)T/n atural killer (NK) cell population. One patient with persistently high leve ls of donor alleles in his CD8*T/NK cell population was diagnosed with seve re graft-versus-host disease (GVHD) and died of opportunistic infections, A nother patient with biopsy-proven GVHD was chimeric in several cell populat ions. On resolution of her symptoms, donor alleles were reduced to levels u ndetectable by this assay. These results suggest that persistently elevated levels of donor CD8(+)T/NK cells in the periphery may indicate GVHD in liv er transplant recipients. This technique aids in rapid diagnosis, which fac ilitates appropriate treatment and thus may improve clinical outcome. Copyr ight (C) 2000 by the American Association for the Study of Liver Diseases.