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liver transplantThis afternoon during lunch, one of my colleagues tipped me off to a story about a girl who had switched blood types after a liver transplant.
Let that sink in for a minute.

Now, here's the reality: normally, when one receives an organ from a donor, an immune response is mounted. Recall that the MHC proteins on the outside of an individual's cells are specific to that person alone, and are the determinants of self vs. non-self. In other words, the recipient's immune system mounts an immune response because it recognizes the donor's cells as foreign (and potentially harmful). The battle that ensues results in what is commonly known as graft versus host disease (GVHD) and can lead to death of the organ recipient if not treated immediately.


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After reading the actual article's source (from the New England Journal of Medicine), I learned a little more about what went on in this girl. Apparently, she received a liver from a young boy whose tissue and blood type closely matched her own and who also happened to be infected with the same virus (CMV) that she had been infected with. Post-transplant, she had a few complications (had to have additional surgeries, some complications related to her CMV infection) but nearly a year post-transplant, doctors discovered during a routine blood test that the girl had developed a new blood type: from O Rh- to O Rh+.

Of course this baffled the doctors, who then performed several immunological and genetic tests to determine how and why her blood type had changed.


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One of the tests, a procedure known as fluorescent in-situ hybridization, or FISH, uses specialized dyes to locate specific DNA sequences on chromosomes. FISH is often used to identify species or to look for certain genetic markers on chromosomes. By using this protocol, doctors were able to determine that the girl's white blood cells contained a blend of her genes as well as the donor's genes. Both X and Y chromosomes were present in about half of the cells tested, which indicated that a process called chimerism had occurred. Chimerism results when an organism's genes consist of DNA from two different sources, which certainly was true in this instance.


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This situation raises a lot of interesting questions. One question that was raised in class was, what will happen when this girl (who is 15 now) decides to have children? Her bone marrow cells are chimeras, but her gametes are not. What implications does this have for people receiving organs from young donors? Will this affect the way transplant medicine is practiced? Could this make it easier or more difficult for people to receive organs?

Posted by scienceguru on January 26, 2008
Tags science is cool!, stem cells

Total comments on this page: 20

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Jocelynn on whole page :

This is definetly an amazing discovery. Usually if an organ transplant has this type of effect, the patient dies. I believe that this 15 year old’s offspring will have birth defects because he chimeras and gametes do not match. Implications involved from recieving organs from young donors are future concerns such as pregnancies and the concern that this girl was a miracle patient and other organ transplant patients may or may not have this same outcome.

January 28, 2008 10:14 am
Kristal Jackson :

That’s a good point. But wouldn’t it be better to get a donation from a younger patient? Their organs aren’t as worn as an older patient’s – her liver could save another’s life if it came down to that.

February 29, 2008 6:14 pm
Jocelyne on paragraph 5:

I think that the FISH method is a remarkable scientific innovation. It amazes me that the idea of using a dye to detect certain DNA sequences has actually become a reality. Science has evolved significantly over the past decade or so.

February 3, 2008 12:24 pm
Jocelyne on paragraph 6:

The only real concern that this discovery will raise is the need for safer testing on all organs before they are used in surgery. I think that the scientific world will just have to wait and see what happens to this girl overtime to decided whether or not she is in any real danger. People have been receiving organ transplants for years since 1905 when the first one was performed, we have come far in this area but mistakes are still a possibilty. However, I doubt it will make it more difficult to perfom organ transplants.

February 3, 2008 12:31 pm
Jocelyne on paragraph 1:

I think that this is a concern for the medical world but there is only one known case that we know of. There could still be others out there waiting to be discovered but whether or not it is dangerous might only be determined by what happens to this young girl.

February 3, 2008 12:36 pm
Kelsey Wise on whole page :

I think this is awesome. Though there is confusion within the girl’s body, her overall good health makes the transplant a success, I think. It is curious, though, as to what would happen to her offspring. Perhaps for the future, would it help to restrict transplants for only individuals of the same gender? I think, though, that at this point, scientists do not know enough information to assume too much about what will happen to this girl’s children or what kind of problem this is (if it is a problem at all), and so I think that a string of tests and conjectures will follow this unusual occurence, seeing if it could be repeated, if it was just a rare occurence, what long-term effects are, etc.

February 5, 2008 11:04 am
David Golynskiy on whole page :

This is definitely something unusual. A person becoming a chimera because of a transplant. I feel kinda sorry for the girl though. I think that when she is going to have problems even becoming pregnant. Her blood type is different from her gametes so it will undoubtedly cause problems. And even if she does become pregnant, I think she will miscarry. However, in a scientific point of view, it will be interesting to see how the chimerism will affect the girl. You never know she might mutate into some super trooper with some super powers and end war on terrorism.

February 17, 2008 12:32 pm
Kaston Murrell :

I can’t think of too many issues the could come up because her gametes don’t match her marrow. If she has children they would have to be C-sections because otherwise the her blood and the baby’s blood would mix. Because she is type O, her baby’s blood could endanger her if her baby isn’t type O, and because she is Rh+ but has Rh- gamete genes, if her baby is Rh- the baby could be endangerd as well. Also, whatever made her change blood types could be looked into. If we can make transplantees accept organ donations without changing blood types (by getting organs from people with the same type) people wouldn’t have to take immunosuppressants to keep from rejecting the organ.

February 28, 2008 5:29 pm
Angie on paragraph 6:

People receiving organs from young donors might not find themselves in similar situations as this girl because the chances of blood types switching is very rare. Of course there is a chance but I don’t think this would pose negative implications to the donor or recipient. The recipient and donor are going to have very similar tissue and blood types to begin with so its unlikely that this will occur frequently enough to be an issue everyone needing organs has to worry about.

February 25, 2008 6:30 pm
Bonnie on paragraph 6:

I am particularly interested in what would happen when this girl eventually decides to have children. Will she be able to? What will happen when her genes are combined with her partners? Are there three parties, in essence, involved in the resulting child’s life? Could this result in deformities or even chromosomal disorders, such as Down syndrome?

February 26, 2008 7:49 pm
Aadil Sarfani on paragraph 6:

Maybe this means that you don’t HAVE to have the same blood type to perform organ transplants. There might be a way around it. This, I think, could potentially make it easier to receive organs. This is one of those things that goes to show how much we don’t know about biology and how the body works.

February 26, 2008 9:58 pm
sussana elkassih on whole page :

Okay, that right there is astounding. Changing blood types?! Could she have changed blood types due to the growth of the stem cells in her bone marrow? So, if the girl decides to have children when she becomes older, wouldn’t her child result with the genetic disorder down syndrome due to the extra amount of chromosomes the baby would have as a result of the girls presence of X and Y chromosomes? Although, the change in blood types for the little girl is amazing, I see no disadvantage unless it was a change from blood type O. Because the change in blood types that might arise from organ transplants, the growing of new organs synthetically looks pretty good right about now (from the previous blog article).

February 27, 2008 6:54 pm
Brigham on paragraph 1:

Wait a second, how can you change blood types and still live, wouldn’t your body attack your blood because it didn’t recognize it? This is a pretty crazy occurence because there has only been one occurence of it, and you’d think with all the transplants going on these days, that this might happen more often. Surprising…I think so.

February 28, 2008 6:46 pm
Brigham on paragraph 6:

I would suppose that her ability to HAVE children won’t be impaired, but the child might have a little trouble in the womb while maturing because of the blood that it is recieveing from the mother and the blood that it has itself. This may pose problems, and it might not until the baby is fully functional. This brings the question, how active is a babies immune system while it is maturing in the uterus?

February 28, 2008 6:54 pm
Kishan on paragraph 6:

This is a really interesting cenario, usually the body’s immune system would reject the new organ, but in this case that didn’t happen. This would make it much easier for people to get donar organs, well that is when we can figure out how to repeat what had just happened. Once we do that, more people will be able to get donar organs, even if the blood types don’t match.

February 28, 2008 9:18 pm
Joshua Geevarghese on paragraph 3:

i am suprised that her blood type changed. this could change the whole transpantation process in medicine. this could make waiting list longer. i am confused about what will happen to the child if she decides to have one

February 28, 2008 9:29 pm
Isha Banerjea on whole page :

As Kaston replied above, the mother would have to undergo a c-section, in order to protect herself and the child, however, just because it is the most effective way for her to give birth, it doesn’t mean that they’re are no risks. Just because the c-section is being used in higher-demand now then that of a vaginal birth doesn’t not mean that it has been perfected. Blood types can still transfer from mother to child, after all the baby’s blood is derived from that of the mother’s.

February 29, 2008 8:15 am
Kristal Jackson on whole page :

If the body can make a baby from spare bits of biological matter in only 9 months, then I’m sure that the body can do pretty much anything. This article really didn’t surprise me, but it does have a definite scientific impact. Does this mean that anyone else who recieves a liver can change blood type? Would it be easier to get a certain type of blood for donations? I think it’s pretty awesome that the body didn’t reject the liver and switched blood types. I think that this means that the liver plays an extremely important role in the way our blood is produced.

February 29, 2008 2:46 pm
Marcos on whole page :

Shall I play the devil’s advocate and remind you all of the possibility that the first routine blood test could have been faulty? But seriously, I mean the chances for that are probably as good as the chances for, say, someone changing blood type. ahem.

February 29, 2008 7:01 pm
Marcos on whole page :

Now for some substance: I believe that this occurence is undoubtedly due to the fact the the donor and recipient were young children, not fully developed. I would venture a guess that young donars in the 9-year old range are relatively hard to come by, and thus situations such as these don’t arise all to often. The only way to know how rare this seeming phenomenon really is would be to track a great deal of similar situations i.e. liver transplant, pre-pubescent male and female. I also wonder if chimerism would occur if this were a female donating to a male
situation. Also how exactly does chimerism work? Does it enter during a stage of mitosis? We don’t have any crossing over to account for the gene exchange, so what’s up?

February 29, 2008 7:03 pm
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