Author of

• 12853

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12895

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    P3.24-043 - Donor - derived metastatic lung cancer in a liver transplant recipient (ID 2858)

    09:30 - 09:30  |  Author(s): D.D. Douglas
    • Abstract

    Background
    Malignancy after organ transplantation is generally the result of de-novo occurrence or recurrence of prior malignancy. Donor-related malignancy, defined as direct transmission of tumor from the donor organ or tumor arising from cells of donor origin in a recipient of a solid organ or hematopoietic stem cell transplant, is less common (0.02-0.2% of solid organ transplants). When organs from donors with known malignancy are used, the rate of transmission is up to 45%, with a mortality of 33-42%. We present the first case of donor-transmitted lung cancer in 550 liver transplants at Mayo Clinic Arizona.

    Methods
    Case report and literature review.

    Results
    A 69 year-old Caucasian male, former smoker, underwent deceased-donor liver transplantation for alcoholic cirrhosis and hepatocellular carcinoma. He was seen for a routine 4 month follow-up visit, had no complaints and was compliant with immunosuppression. Physical exam and laboratory tests were unremarkable. Abdominal CT revealed 3 small, solid, indeterminate liver masses. Follow-up MRI 6 weeks later demonstrated an increase in number and size of liver lesions. US-guided biopsy revealed poorly differentiated carcinoma most consistent with non-small cell carcinoma of the lung, with a minor component of small cell carcinoma. On PET-CT, the abnormal uptake was limited solely to the liver. Suspicion of donor-transmitted malignancy arose. The donor was a 50 year-old man, with history of alcohol and nicotine dependence (>20 pack/year), without history of malignancy. Chest x-ray, bronchoscopy and surgical lung examination, performed as part of procurement protocol, were normal. No other organ from this donor was transplanted. A PCR-panel of markers that recognize highly variable regions of DNA was used to compare donor liver tissue to the tumor and recipient liver tissue. Results confirmed cancer cells were of donor origin. Cancer was confined to the donor organ, but the patient could not undergo graft removal and re-transplantation. Immunosuppression was reduced, and chemotherapy (etoposide & carboplatin) was begun with initial response. Progression of metastatic liver disease led to second-line therapy with erlotinib. Unfortunately, patient succumbed shortly thereafter.

    Conclusion
    Donor-derived bronchogenic carcinoma after solid organ transplantation is extremely rare. One series reported lung cancer in 9 of 3374 patients (0.3%) transplanted over a 15 year period. Of these 9 patients, 3 patients had a kidney transplant, 3 had liver transplant, 2 had heart transplant and 1 had lung transplant. Treatment includes reduction/discontinuation of immunosuppression, chemotherapy and/or radiation therapy as appropriate, as well as removal of the transplanted organ and re-transplantation when feasible. In the present case we hypothesize that the donor had an undiagnosed lung cancer with subclinical hepatic metastases transmitted to our patient at the time of liver transplantation. Donor-derived lung cancer is extremely rare and can lead to significant morbidity and mortality. Proper diagnosis of donor origin is critical since it has a significant impact on management of these patients.