Novel surveillance and cure of a donor-transmitted lymphoma in a renal allograft recipient

TitleNovel surveillance and cure of a donor-transmitted lymphoma in a renal allograft recipient
Publication TypeJournal Article
Year of Publication2000
AuthorsHerzig KA, Falk MC, Jonsson JR, Axelsen RA, Griffin AD, Hawley CM, Rigby RJ, Cobcroft R, Nicol DL, Powell EE, Johnson DW
JournalTransplantation
Volume70
Issue1
Pagination149 - 52
Date PublishedJul 15
ISSN0041-1337 (Print) 0041-1337 (Linking)
Accession Number10919592
Keywords*Tissue Donors, Aged, Chimera, Female, Humans, Immunosuppression, Kidney Transplantation / *adverse effects, Lymphoma, B-Cell / diagnosis / etiology / *therapy, Male, Middle Aged, Polymerase Chain Reaction, Transplantation, Homologous
Abstract

BACKGROUND: In this report we describe a malignant lymphoma of donor origin inadvertently transplanted into two renal allograft recipients, despite standard comprehensive donor screening. The successful clearance of the tumor from both patients and a novel method of surveillance are detailed. METHODS: Initial management consisted of withdrawal of immunosuppression to promote rejection of the allograft and the transplanted tumor in both patients, followed by graft removal. Peripheral blood microchimerism was assessed in both recipients using nested polymerase chain reaction to detect the DYZ3 gene on the Y chromosome (donor male, recipients female). RESULTS: Although microchimerism was detected on day 6 after transplantation and day 1 after explantation, repeat peripheral blood examination at 1, 3, and 6 months after explantation demonstrated no microchimerism. Both patients remain well at 12 months and have been relisted for transplantation. CONCLUSION: Despite inadvertent transplantation of a previously undiagnosed malignancy of donor origin, the recipients' immune response was able to eliminate donor tumor cells after the withdrawal of immunosuppression. Repeated surveillance of peripheral blood from both recipients, using a novel application of the technique of nested polymerase chain reaction to amplify donor DNA, demonstrated no persistence of donor cells, supporting effective eradication of the donor malignancy.

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