Retransplantation for donor-derived neuroendocrine tumor

: Although tumor transmission through liver transplantation (LT) is a rare occurrence, the consequences can be devastating, even when a very aggressive management approach is adopted. We report the case of a donor-derived small cell neuroendocrine tumor (NET) in a patient who underwent LT for cholangiocarcinoma. Despite locoregional therapy, chemotherapy and ultimately retransplantation, the patient died from metastases. The high grade nature of the NET was the most important determinant of prognosis in this case. Our experience suggests that retransplantation for donor-derived NET should only be considered when tumor biology is favorable. Liver Transpl 17:83-87, 2011. (C) 2011 AASLD. Copyright (C) 2011 John Wiley & Sons, Inc.; References: 1. Myron Kauffman H, McBride MA, Cherikh WS, Spain PC, Marks WH, Roza AM. Transplant tumor registry: donor related malignancies. Transplantation 2002; 74: 358-362. 2. Heimbach JK, Gores GJ, Haddock MG, Alberts SR, Nyberg SL, Ishitani MB, Rosen CB. Liver transplantation for unresectable perihilar cholangiocarcinoma. Semin Liver Dis 2004; 24: 201-207. 3. Rea DJ, Heimbach JK, Rosen CB, Haddock MG, Alberts SR, Kremers WK, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 2005; 242: 451-458; discussion 458-461. 4. De Vreede I, Steers JL, Burch PA, Rosen CB, Gunderson LL, Haddock MG, et al. Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. Liver Transpl 2000; 6: 309-316. 5. Cankovic M, Linden MD, Zarbo RJ. Use of microsatellite analysis in detection of tumor lineage as a cause of death in a liver transplant patient. Arch Pathol Lab Med 2006; 130: 529-532. 6. Snape K, Izatt L, Ross P, Ellis D, Mann K, O'Grady J. Donor-transmitted malignancy confirmed by quantitative fluorescence polymerase chain reaction genotype analysis: a rare indication for liver retransplantation. Liver Transpl 2008; 14: 155-158. 7. Baehner R, Magrane G, Balassanian R, Chang C, Millward C, Wakil AE, et al. Donor origin of neuroendocrine carcinoma in 2 transplant patients determined by molecular cytogenetics. Hum Pathol 2000; 31: 1425-1429. 8. Donovan JA, Simmons FA, Esrason KT, Jamehdor M, Busuttil RW, Novak JM, Grody WW. Donor origin of a posttransplant liver allograft malignancy identified by fluorescence in situ hybridization for the Y chromosome and DNA genotyping. Transplantation 1997; 63: 80-84. 9. Stephens JK, Everson GT, Elliott CL, Kam I, Wachs M, Haney J, et al. Fatal transfer of malignant melanoma from multiorgan donor to four allograft recipients. Transplantation 2000; 70: 232-236. 10. Mullhaupt B. Neuroendocrine Tumors: Liver Aspects. Presented at The International Liver Congress 2009: 44th Annual Meeting of the EASL. April 22-26, 2009; Copenhagen, Denmark; 2009: 81-86. 11. Lehnert T. Liver transplantation for metastatic neuroendocrine carcinoma: an analysis of 103 patients. Transplantation 1998; 66: 1307-1312. 12. Madoff DC, Gupta S, Ahrar K, Murthy R, Yao JC. Update on the management of neuroendocrine hepatic metastases. J Vasc Interv Radiol 2006; 17: 1235-1249. 13. Florman S, Bowne W, Kim-Schluger L, Sung MW, Huang R, Fotino M, et al. Unresectable squamous cell carcinoma of donor origin treated with immunosuppression withdrawal and liver retransplantation. Am J Transplant 2004; 4: 278-282. 14. Le Treut YP, Gregoire E, Belghiti J, Boillot O, Soubrane O, Mantion G, et al. Predictors of long-term survival after liver transplantation for metastatic endocrine tumors: an 85-case French multicentric report. Am J Transplant 2008; 8: 1205-1213. 15. Coppa J, Pulvirenti A, Schiavo M, Romito R, Collini P, Di Bartolomeo M, et al. Resection versus transplantation for liver metastases from neuroendocrine tumors. Transplant Proc 2001; 33: 1537-1539. 16. Mazzaferro V, Pulvirenti A, Coppa J. Neuroendocrine tumors metastatic to the liver: how to select patients for liver transplantation? J Hepatol 2007; 47: 460-466. 17. Rosenau J, Bahr MJ, von Wasielewski R, Mengel M, Schmidt HH, Nashan B, et al. Ki67, E-cadherin, and p53 as prognostic indicators of long-term outcome after liver transplantation for metastatic neuroendocrine tumors. Transplantation 2002; 73: 386-394. 18. Morris-Stiff G, Steel A, Savage P, Devlin J, Griffiths D, Portman B, et al. Transmission of donor melanoma to multiple organ transplant recipients. Am J Transplant 2004; 4: 444-446. 19. Lipshutz GS, Baxter-Lowe LA, Nguyen T, Jones KD, Ascher NL, Feng S. Death from donor-transmitted malignancy despite emergency liver retransplantation. Liver Transpl 2003; 9: 1102-1107. 20. Kauffman HM, McBride MA, Delmonico FL. First report of the United Network for Organ Sharing Transplant Tumor Registry: donors with a history of cancer. Transplantation 2000; 70: 1747-1751.