Long-term observations on a patient with severe combined immunodeficiency after transplantation with cultured thymic epithelium

Long-term observations in a fatal case of severe combined immunodeficiency (SCID) after transplantation with cultured thymic epithelium are described. After initial thymic transplantation, the patient had partial, although significant immunologic reconstitution. Eight months after the initial transplantation, she had recurrent infections, lost functional antibody titers to a variety of antigens, and became anergic. A second transplant, 13 months after the first, using cultured thymic epithelial fragments, failed to produce improvement in her clinical and immunologic status. Four months after the second transplantation, she died of a viral myocarditis. The patient's clinical course, postmorten findings, and their implication for future reconstitution efforts are discussed.