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Meng X, Yang B, Wu D, Pan T, Zhang F, Xie H, Xie W, Chen X, Zheng S. Short Tandem Repeat Analysis in a Living Related Donor Adult Renal Transplant Recipient with Rare Natural Chimerism. EXP CLIN TRANSPLANT 2023; 21:917-920. [PMID: 38140935 DOI: 10.6002/ect.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
After renal transplant, immunosuppression therapy is used to reduce the risk of rejection. Here, we describe the case of an adult living related donor renal transplant recipient with rare natural chimerism, as discovered by short tandem repeat sequence analysis. In our process of matching transplant patients, we perform human leukocyte antigen testing and short tandem repeat chimerism testing to decide postoperative immunosuppression strategy for transplant patients. We analyzed the short tandem repeat chimerism status before renal transplant and determined that this patient represented a rare case of natural chimerism. Assessment of organ recipient chimerism can inform physicians regarding a dosage reduction of immunosuppressive agents. Short tandem repeat sequence analysis provides substantial information regarding existing polymorphisms and can identify chimerism, if present, and thereby guide immunosuppression strategies after renal transplant, which may improve the long-term immunosuppression-free survival of renal transplant recipients.
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Affiliation(s)
- Xueqin Meng
- From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery and the NHC Key Laboratory of Combined Multi-organ Transplantation, The First Affiliated Hospital, Hangzhou, China
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Lapointe M, Kerbaul F, Meckert F, Cognard N, Mathelin C, Lodi M. [Breast cancer and organ transplantation: Systematic review and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:60-72. [PMID: 36375787 DOI: 10.1016/j.gofs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Affiliation(s)
- M Lapointe
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - F Kerbaul
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - F Meckert
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - N Cognard
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
| | - M Lodi
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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Mrzljak A, Kocman B, Skrtic A, Furac I, Popic J, Franusic L, Zunec R, Mayer D, Mikulic D. Liver re-transplantation for donor-derived neuroendocrine tumor: A case report. World J Clin Cases 2019; 7:2794-2801. [PMID: 31616694 PMCID: PMC6789388 DOI: 10.12998/wjcc.v7.i18.2794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT).
CASE SUMMARY A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination.
CONCLUSION The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.
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Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Branislav Kocman
- Department of Surgery, Merkur University Hospital, Zagreb 10000, Croatia
| | - Anita Skrtic
- Department of Pathology and Cytology, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Ivana Furac
- DNA Laboratory, Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Jelena Popic
- Department of Radiology, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Lucija Franusic
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Renata Zunec
- Department for Tissue Typing, Clinical Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Davor Mayer
- Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Surgery, Merkur University Hospital, Zagreb 10000, Croatia
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Donor-Derived Hepatic Neuroendocrine Tumor: Pause Before Proceeding With Liver Retransplantation. Transplant Direct 2016; 2:e88. [PMID: 27830182 PMCID: PMC5087570 DOI: 10.1097/txd.0000000000000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal neuroendocrine tumors (NET) are rare but the age-adjusted incidence in the United States has increased, possibly due to improved radiographic and endoscopic detection. In advanced NET, hepatic metastases are common. Orthotopic liver transplant (OLT) is currently considered an acceptable therapy for selected patients with limited hepatic disease or liver metastases where complete resection is thought to have curative intent. The development of NET of donor origin is very uncommon after organ transplant, and it is unclear if the same treatment strategies applied to hepatic NET would also be efficacious after OLT. Here, we describe a unique case of an OLT recipient with a donor-derived NET that was treated with redo OLT as the primary therapy. The donor-derived NET recurred in the recipient's second liver allograft suggesting an extrahepatic reservoir. This case describes the natural history of such a rare event. Here, we highlight the treatment options for hepatic NET and challenge the role of OLT for a donor-derived hepatic NET.
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Desai R, Neuberger J. Donor transmitted and de novo cancer after liver transplantation. World J Gastroenterol 2014; 20:6170-6179. [PMID: 24876738 PMCID: PMC4033455 DOI: 10.3748/wjg.v20.i20.6170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/02/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Cancers in solid organ recipients may be classified as donor transmitted, donor derived, de novo or recurrent. The risk of donor-transmitted cancer is very low and can be reduced by careful screening of the donor but cannot be abolished and, in the United Kingdom series is less than 0.03%. For donors with a known history of cancer, the risks will depend on the nature of the cancer, the interventions given and the interval between diagnosis and organ donation. The risks of cancer transmission must be balanced against the risks of death awaiting a new graft and strict adherence to current guidelines may result increased patient death. Organs from selected patients, even with high-grade central nervous system (CNS) malignancy and after a shunt, can, in some circumstances, be considered. Of potential donors with non-CNS cancers, whether organs may be safely used again depends on the nature of the cancer, the treatment and interval. Data are scarce about the most appropriate treatment when donor transmitted cancer is diagnosed: sometimes substitution of agents and reduction of the immunosuppressive load may be adequate and the impact of graft removal should be considered but not always indicated. Liver allograft recipients are at increased risk of some de novo cancers, especially those grafted for alcohol-related liver disease and hepatitis C virus infection. The risk of lymphoproliferative disease and cancers of the skin, upper airway and bowel are increased but not breast. Recipients should be advised to avoid risk behavior and monitored appropriately.
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Osisami M, Keller ET. Mechanisms of Metastatic Tumor Dormancy. J Clin Med 2013; 2:136-50. [PMID: 26237067 PMCID: PMC4470233 DOI: 10.3390/jcm2030136] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/20/2013] [Accepted: 09/10/2013] [Indexed: 12/29/2022] Open
Abstract
Tumor metastasis can occur years after an apparent cure due to a phenomenon known as metastatic tumor dormancy; in which tumor masses or individual tumor cells are growth restricted for extended periods of time. This period of dormancy is induced and maintained by several mechanisms, including: (1) Tumor microenvironment factors such as cytokine expression, immunosurveillance and angiogenesis; (2) Metastasis suppressor gene activity; and (3) Cancer therapeutics. Disseminated tumor cells (DTC) are the key cells that result in dormant tumors. However, many challenges exist towards isolating DTCs for mechanistic studies. The main DTC that may represent the dormant cell is the cancer stem cells (CSC) as they have a slow proliferation rate. In addition to limited knowledge regarding induction of tumor dormancy, there are large gaps in knowledge regarding how tumors escape from dormancy. Emerging research into cancer stem cells, immunotherapy, and metastasis suppressor genes, may lead to new approaches for targeted anti-metastatic therapy to prevent dormancy escape. Overall, an enhanced understanding of tumor dormancy is critical for better targeting and treatment of patients to prevent cancer recurrence.
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Affiliation(s)
- Mary Osisami
- Department of Urology, University of Michigan Medical School, 5111 CCGC1500 E. Medical Center, Ann Arbor, MI 48109-0940, USA.
| | - Evan T Keller
- Department of Urology, University of Michigan Medical School, 5111 CCGC1500 E. Medical Center, Ann Arbor, MI 48109-0940, USA.
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Abstract
Several criteria are used to differentiate between standard and extended allograft donors. These criteria include deceased after cardiac death, advanced donor age, steatosis, previous malignancy in the donor, hepatitis C virus-positive allografts, human T-cell lymphotropic virus-positive allografts, active infections in the donor, high-risk donors, split liver transplantations, and living donor liver transplantations. Review of the literature can lead each practitioner to incorporate extended criteria donors into their transplant program, thereby individualizing the use of these allografts, increasing the donor pool, and decreasing overall waitlist mortality.
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Affiliation(s)
- Theresa R Harring
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Foltys D, Zimmermann T, Heise M, Kaths M, Lautem A, Wisser G, Weiler N, Hoppe-Lotichius M, Hansen T, Otto G. Liver transplantation for hepatocellular carcinoma--is there a risk of recurrence caused by intraoperative blood salvage autotransfusion? ACTA ACUST UNITED AC 2011; 47:182-7. [PMID: 21986299 DOI: 10.1159/000330746] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/28/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC). METHODS In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group). RESULTS Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group. CONCLUSION Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.
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Affiliation(s)
- D Foltys
- Department of Transplantation and Hepatobiliary Surgery, University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
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O'Neill ID. Tasmanian devil facial tumor disease: insights into reduced tumor surveillance from an unusual malignancy. Int J Cancer 2010; 127:1637-42. [PMID: 20473867 DOI: 10.1002/ijc.25374] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Tasmanian devil facial tumor disease (DFTD) is a highly aggressive cancer involving the facial tissues that currently presents a serious extinction risk for the Tasmanian devil population. Although the histogenesis is uncertain, an origin from a neural crest cell-lineage is considered likely. Epidemiological, cytogenetic and immunological data all support the premise that DFTD arose from a single tumor clone from an individual diseased animal, and is being transmitted between individual animals as a tumor "allograft" by biting during social interaction. The spread of this cancer throughout the species is believed to be facilitated by a reduced MHC diversity, possibly as a result of an evolutionary bottleneck. The pathogenesis of DFTD has some similarities with certain human cancers, including donor-recipient tumor transmission, which may complicate organ transplantation, and certain forms of malignancy at the maternal/fetal interface. The natural history and pathology of DFTD, and the data describing this highly unusual tumor biology are discussed.
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Affiliation(s)
- Iain D O'Neill
- de L'immeuble 3, Centre d'Affaires Poincaré, 3 Rue Poincaré, 06000, Nice, France
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