Evidence that pediatric liver transplant recipients may undergo late rejection episodes in spite of donor-specific microchimerism

Lymphocytes of donor origin can be demonstrated in the blood of many liver transplant recipients. It has been proposed that this chimerism may imply graft tolerance and permit withdrawal of immunosuppression. We report two children with liver transplants who had lymphocyte chimerism demonstrated at the time of late rejection episodes. One child was chimeric for both of his donors, although he retained the first allograft for only 3 days. Thus, the persistence of donor lymphocytes may be unrelated to the presence of the donor organ. Graft rejection can occur in spite of donor-specific microchimerism. The role of donor-specific microchimerism in graft acceptance or graft tolerance remains to be elucidated.