An Australian paediatric liver transplant recipient has created world news by taking on the immune system of her organ donor. The female patient, now aged 15 years, suffered acute fulminant hepatitis after a non-specific viral illness at 9 years of age for which liver transplant was performed. The postoperative course was complicated by acute biliary obstruction, profound lymphopaenia, haemolytic anaemia, and cytomegalovirus (CMV) infection. Over the following 12 months, clinicians were surprised to discover that the recipient’s immune system appeared to have undergone complete haemopoietic chimerism, resulting in tolerance of the liver allograft. The recipient has taken on the blood type of the donor and lost antibody responses to measles and mumps, against which she had been previously immunised. All immunosuppressive therapy has since been withdrawn and the patient remains well, with no evidence of graft-versus-host disease and normal liver function. The authors comment that the profound lymphopaenia experienced by the child and the immunosuppressive effects of therapy, in combination with the early CMV infection, may have contributed to the engraftment of donor cells.
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