Metastatic Donor-derived Malignancies Following Simultaneous Pancreas-kidney Transplant: Three Case Reports and Management Strategies

Dominic Amara, BA; Steven A. Wisel, MD; Hillary J. Braun, MD; Eric A. Collisson, MD; Terence Friedlander, MD; Giulia Worner, NP; Garret R. Roll, MD; Ryutaro Hirose, MD; Peter G. Stock, MD, PhD

doi:10.1097/TXD.0000000000001090

Transplantation Direct (Jan 2021)

Metastatic Donor-derived Malignancies Following Simultaneous Pancreas-kidney Transplant: Three Case Reports and Management Strategies

Dominic Amara, BA,
Steven A. Wisel, MD,
Hillary J. Braun, MD,
Eric A. Collisson, MD,
Terence Friedlander, MD,
Giulia Worner, NP,
Garret R. Roll, MD,
Ryutaro Hirose, MD,
Peter G. Stock, MD, PhD

Affiliations

Dominic Amara, BA: 1 School of Medicine, University of California, San Francisco, San Francisco, CA.
Steven A. Wisel, MD: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.
Hillary J. Braun, MD: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.
Eric A. Collisson, MD: 3 Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.
Terence Friedlander, MD: 3 Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.
Giulia Worner, NP: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.
Garret R. Roll, MD: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.
Ryutaro Hirose, MD: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.
Peter G. Stock, MD, PhD: 2 Department of Surgery, University of California, San Francisco, San Francisco, CA.

DOI: https://doi.org/10.1097/TXD.0000000000001090
Journal volume & issue: Vol. 7, no. 1
p. e636

Abstract

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Background. Stopping immunosuppression in a transplant patient with donor-derived malignancy offers the theoretical benefit that reconstitution of the patient’s immune system will allow “rejection” of the malignancy, as the malignancy also originates from allogeneic tissue. However, this option exists with the caveat that the patient’s allograft(s) will likely be rejected too. In simultaneous pancreas-kidney (SPK) recipients, the normal continued functioning and possible absence of malignancy in either the unaffected kidney or pancreas further complicate this decision. Methods. The charts of 3 patients with donor-derived metastatic malignancies after SPK were retrospectively reviewed in detail. We provide treatment and management recommendations based on successful outcomes and a review of the existing literature. Results. Consistent with a broad review of the literature, in all 3 cases, complete immunosuppression cessation, removal of both grafts, and in 1 case treatment with an immune checkpoint inhibitor to augment the immune response was successful. One patient is doing well 1 year after successfully undergoing kidney retransplantation, while a second patient is active on the waitlist for SPK retransplantation after no evidence of metastatic disease for 2 years. Conclusion. The successful management of metastatic donor-derived malignancies requires allograft removal, immunosuppression cessation, and adjuvant therapy that includes occasional use of checkpoint inhibitors to augment the immune response.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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