Search

We report the case of a 26-year-old man with acute myeloid leukemia (AML) who underwent bone marrow transplantation (BMT) from an HLA-identical sibling-donor when in first complete remission. He developed a dilated cardiomyopathy 9 months post-BMT and subsequently underwent orthotopic heart transplantation. He remains in complete hematological remission more than 12 months after surgery with normal cardiac function and an excellent performance status. Although cardiac transplantation has been carried out for chemotherapy-induced cardiomyopathy in cancer patients, to our knowledge cardiac transplantation following BMT has not been reported previously.

Our group has shown previously that APC-depleted cultured epidermal keratinocytes show prolonged survival when grafted onto normal MHC-incompatible adult mice. We show here that in vitro culture also improves significantly the survival of MHC-compatible keratinocyte allografts, although these nonrejected grafts are repopulated by host cells identified by their dendritic morphology and phenotype (class II+, leukocyte-common antigen+) as APCs. Reconstitution of cultured grafts, immediately prior to transplantation, with MHC-compatible dendritic cells of either donor or recipient origin, results in graft rejection--thus demonstrating that cultured cells can be rejected by the recipient animal--and suggests that a paucity of APCs in the immediate postgrafting period is responsible for the privilege afforded these grafts.