Case Report: Primary De Novo Sarcoma In Transplant Pancreas Allograft

Nagaraju, Santosh; Grethlein, Sara J.; Vaishnav, Smruti B; Sharfuddin, Asif; Powelson, John A.; Fridell, Jonathan A.

doi:10.1016/j.transproceed.2017.10.007

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…The selection of postoperative adjuvant therapy is related to the type of new tumor, the degree of malignancy, and the location of transplanted organs. Systemic chemotherapy or radiotherapy is usually limited to advanced cases and recurrent diseases [69].…”

Section: Morbidity Of Carcinoma Of Postheart Transplantationmentioning

confidence: 99%

[Retracted] Current Status of Malignant Tumors after Organ Transplantation

Shen

Cen

Tan

et al. 2022

BioMed Research International

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Objective. To analyze the diagnosis and treatment of patients with concomitant malignant tumors after organ transplantation by compiling data from organ transplantation patients. Methods. By searching CNKI and PubMed databases, we made a systematic analysis of the studies of postorgan transplantation complicating malignant tumors in the last decade. Results. There were 10 articles on malignant tumors after renal transplantation, 8 articles on liver transplantation, 2 articles on heart transplantation, and 1 article on lung transplantation. The incidence of malignant tumors complicating renal transplantation is 10.4% in Europe, with skin cancer and Kaposi’s sarcoma being common; the incidence in the United States is 3.4%, with PTLD having the highest incidence; the incidence of malignant tumors is relatively lowest in Asia, with gastrointestinal malignancies being the main ones. The mean time to complication of malignancy after renal transplantation is 3.83 years. The incidence of concurrent malignancies after liver transplantation is 8.8% in Europe, where skin cancer and Kaposi’s sarcoma are common; 5.6% in Asia, where gastrointestinal tract tumors are prevalent; and 4.5% in the United States, where gastrointestinal tract tumors, PTLD, and hematologic diseases are predominant. The mean time to complication of malignancy after liver transplantation is 4.79 years. The incidence of malignancy after heart transplantation is 6.8-10.7%. The incidence of malignancy after lung transplantation is about 10.1%. Minimization of immunosuppression or modification of immunosuppression regimens may be a key component of cancer prevention. mTOR inhibitors and phenolate (MMF) reduce the incidence of de novo malignancies in patients after solid organ transplantation. Surgical treatment improves survival in patients with early malignancies. The use of external beam radiation therapy in the treatment of hepatocellular carcinoma is limited due to the risk of radiation liver disease. Conclusions. The risk of concomitant malignancy needs to be guarded for 5 years of immunosuppressive therapy after organ transplantation surgery. Adjusting the immunosuppressive treatment regimen is an effective way to reduce concurrent malignancies. Systemic chemotherapy or radiotherapy requires vigilance against the toxic effects of drug metabolism kinetics on the transplanted organ.

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Section: Morbidity Of Carcinoma Of Postheart Transplantationmentioning

confidence: 99%

[Retracted] Current Status of Malignant Tumors after Organ Transplantation

Shen

Cen

Tan

et al. 2022

BioMed Research International

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Section: Discussionmentioning

confidence: 99%

“…7 Nagaraju et al reported a case of a soft tissue sarcoma arising in a pancreas allograft, which was not tested for donor origin but nevertheless successfully treated with graft pancreatectomy and immunosuppression cessation. 8 Focusing on SPK patients, Roza et al reported the first donor-derived malignancy in a transplanted pancreas in an SPK recipient in 2001. However, this patient died of malignancy after transplant pancreatectomy, immunosuppression cessation, and 2 chemotherapy courses.…”

Section: Discussionmentioning

confidence: 99%

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

Amara

Wisel

Braun

et al. 2020

Transplantation Direct

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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.

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“…By 2000, the proportion had shifted to 35% bladder-drained vs. 65% enteric-drained, 4 progressing to less than 10% bladder-drained over the decade prior to this publication. 3 Most reports of donor-derived malignancies after pancreas transplantation have been pancreatic adenocarcinomas, 5,6 although sarcomas 7 have also been described. These have been managed with cessation of immunosuppression, allograft resection and systemic antineoplastic therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Most reports of donor‐derived malignancies after pancreas transplantation have been pancreatic adenocarcinomas, 5,6 although sarcomas 7 have also been described. These have been managed with cessation of immunosuppression, allograft resection and systemic antineoplastic therapy 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Donor-derived duodenal adenocarcinoma of a bladder-drained pancreas allograft

Isaacson

Steggerda

Xue

et al. 2022

American Journal of Transplantation

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The subset of the population that received bladder‐drained allograft pancreata during peak utilization of the technique in the 1990s is approaching 20–30 postoperative years. This time frame is salient, as it parallels the time in which patients in the urologic literature develop adenocarcinomas after bladder reconstruction using gastrointestinal segments. We present the case of a 57‐year‐old simultaneous pancreas/kidney recipient who presented with microhematuria twenty‐four years after transplantation and was found to have an adenocarcinoma of the duodenum of his failed, bladder‐drained pancreas. After allograft pancreatectomy/duodenectomy, he remains disease‐free eleven months postoperatively. As this patient population ages, practitioners should consider pathology of the donor duodenum and pancreas in recipients who present with gross or microscopic hematuria.

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Case Report: Primary De Novo Sarcoma In Transplant Pancreas Allograft

Cited by 7 publications

References 11 publications

[Retracted] Current Status of Malignant Tumors after Organ Transplantation

[Retracted] Current Status of Malignant Tumors after Organ Transplantation

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

Donor-derived duodenal adenocarcinoma of a bladder-drained pancreas allograft

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