Unresectable Squamous Cell Carcinoma of Donor Origin Treated With Immunosuppression Withdrawal and Liver Retransplantation

Abstract

Posttransplantation allograft malignancy of donor origin is a rare complication after liver transplantation. In the case described, subjective fevers and nonspecific abdominal complaints nearly 6 months following cadaveric liver transplantation in a young woman prompted an evaluation which was remarkable for a large central liver mass. A poorly differentiated squamous cell carcinoma was diagnosed, but was unresectable at exploration. The tumor was confined to the liver. Histocompatibility testing using polymerase chain reaction (PCR) amplification techniques identified both donor and recipient HLA alleles. The patient was treated with chemoembolization, systemic chemotherapy and cessation of immunosuppression. Repeat biopsy 2 months later showed the tumor to be completely necrotic. With decompensated liver disease, she was relisted and retransplanted. More than 2 years later she remains disease-free with complete pathological remission. This is the only reported case of squamous cell carcinoma of donor origin arising in a transplantd liver.

Donor-transmitted malignancy confirmed by quantitative fluorescence polymerase chain reaction genotype analysis: A rare indication for liver retransplantation

“…The management of patients diagnosed with donor‐derived malignancy also remains a matter for debate. This case, along with other similar cases,2, 5, 10, 11 gives some evidence that emergency retransplantation in hepatic grafts appears to be curative. The role for radioablation, immunosuppression, and chemotherapy is less clear‐cut.…”

“…In sex‐mismatched allografts, this distinction can be made with chromosomal analysis 5, 6. More recently, microsatellite analysis has allowed the detection of tumor lineage of both donor7, 10–14 and recipient origin 15, 16…”

Retransplantation for donor-derived neuroendocrine tumor

“…The patient's good therapeutic response and clinical stability over a period of 6 months suggested that retransplantation should be offered as definitive treatment. We never considered a trial of complete withdrawal of immunosuppression because we believed we had successfully controlled the patient's hepatic disease: a PET/CT scan performed 40 days before retransplantation demonstrated no extrahepatic disease 13…”

Transmission of an undiagnosed sarcoma to recipients of kidney and liver grafts procured in a non-heart beating donor

“…Reducing immunosuppression and switching to a calcineurin inhibitor–free regimen, in addition to radical surgery and/or adjuvant systemic chemotherapy in selected cases, could be justified according to the tumor type and to the patient characteristics. In cases in which the donor cancer was diagnosed several months after transplantation, complete interruption of immunosuppression was proposed to induce cancer rejection 16. This policy, in addition to systemic chemotherapy and retransplantation as the rejection process induces liver graft failure, was successfully reported 16.…”

“…In cases in which the donor cancer was diagnosed several months after transplantation, complete interruption of immunosuppression was proposed to induce cancer rejection 16. This policy, in addition to systemic chemotherapy and retransplantation as the rejection process induces liver graft failure, was successfully reported 16. However, cases of successful liver retransplantation are rare,17 and the management of liver recipients diagnosed with transplanted malignant tumor remains highly challenging.…”