Protocols of donor bone marrow infusion for tolerance induction are receiving increasing attention in clinical trials of organ allotransplantation. We report pulmonary embolism with bone fragments following vertebral body marrow infusion in a recipient of a liver and intestinal transplant. Even though pulmonary embolism with bony microfragments has been widely described following bone marrow transplantation, the use of single, high-dose donor bone marrow infusion and/or multiple infusions currently under clinical investigation for induction of donor specific unresponsiveness, may warrant the implementation of additional steps in the vertebral body marrow processing technique to decrease or eliminate the component of bony microfragments in the final preparation.
AbrahamsC.; CatchatourianR.Bone fragment emboli in the lung of patients undergoing bone marrow transplantation.Am. J. Clin. Pathol.79: 360; 1983.
2.
FontesP.; RaoA.S.; DemetrisA.J.; ZeeviA.; TruccoM.; CarrollP.; RybkaW.; RudertW.A.; RicordiC.; DodsonF.Bone marrow augmentation of donor-cell chimerism in kidney, liver, heart, and pancreas islet transplantation.Lancet344: 151; 1994.
3.
FontesP.A.; RicordiC.; RaoA.S.; RybkaW.B.; DodsonS.F.; McAllisterC.G.; BroznickB.; UkahF.O.; FungJ.J.; StarzlT.E.Human vertebral bodies as a source of bone marrow for cell augmentation in whole organ allograft. In: RicordiC., ed. Methods in cell transplantation.Landes Company: Austin, Texas1995: 619–628.
4.
KongS.S.; SelvaggiG.; KenyonN.S.; BottinoR.; LinetskyE.; RicordiC.A simple method for depletion of bone fragments from human vertebral body marrow.Transplant. Proc.27: 3417, 1995.
5.
KrowkaM.J.; RosenowE.C.; Clark HoaglandH.Pulmonary complications of bone marrow transplantation.Chest87: 237; 1985.
6.
McDanielD.O.; NaftilanJ.; HulveyK.; ShaneyfeltS.; LemonsJ.A.; Lagoo-DeenadayalanS.; HudsonS.; DiethlemA.G.; BarberH.Peripheral blood chimerism in renal allograft recipients transfused with donor bone marrow.Transplantation57: 852; 1994.
7.
MonacoA.P.; WoodM.L.; MakiT.; GozzoJ.J.Attempt to induce unresponsiveness to human renal allograft with antilymphocyte globulin and donor-specific bone marrow.Transplant. Proc.17: 1312; 1985.
8.
RicordiC.; KaratzasT.; SelvaggiG.; NeryJ.; WebbM.; FernandezH.; RuizP.; KongS.S.; EsquenaziV.; MillerJ.; SchiffE.; TzakisA.G.Multiple bone marrow infusions to enhance acceptance of allografts from the same donor.Ann. NY Acad. Sci. In press; 1995.
9.
RybkaW.B.; FontesP.A.; RaoA.S.; WinkelsteinA.; RicordiC.; BallE.D.; StarzlT.E.Hematopoietic progenitor cell content of vertebral body marrow used for combined solid organ and bone marrow transplantation.Transplantation59: 871; 1995.
10.
ShulmanH.M.; SullivanK.M.; WeidenP.L.; McDonaldG.B.; StrikerG.E.; SaleG.E.; HackmanR.; TsoiM.S.; StorbR.; ThomasE.D.Chronic graft-versus-host syndrome in man: A long term clinicopathologic study of 20 Seattle patients.Am. J. Med.69: 204; 1980.
11.
SloaneJ.P.; DepledgeM.H.; PowlesR.L.; MorgensternG.R.; TrickeyB.S.; DadyP.J.Histopathology of the lung after bone marrow transplantation.J. Clin. Pathol.36: 546; 1983.
12.
StarzlT.E.; DemetrisA.J.; MuraseN.; ThomsonA.W.; TruccoM.; RicordiC.Donor cell chimerism permitted by immunosuppressive drugs: A new view of organ transplantation.Immunol. Today14: 326; 1993.
13.
StewartF.M.; CrittendenR.B.; LowryP.A.; Pearson-WhiteS.; QuesenberryP.J.Long-term engraftment of normal and post-5-fluorouracil murine marrow into normal mice.Blood81: 2566; 1993.
14.
StrongM.Seattle protocol: Vertebral body recovery for bone marrow. PRO-550G0.1-5; 1992.
15.
ThomasJ.M.; CarverF.M.; Kasten-JollyJ.; HaischC.E.; RebellatoL.M.; GrossU.; VoreS.J.; ThomasF.T.Further studies of veto activity in rhesus monkey bone marrow in relation to allograft tolerance and chimerism.Transplantation57: 101; 1994.
