Metastatic Donor-derived Malignancies Following Simultaneous Pancreas-kidney Transplant: Three Case Reports and Management Strategies.
Metastatic Donor-derived Malignancies Following Simultaneous Pancreas-kidney Transplant: Three Case Reports and Management Strategies.
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DOI：
10.1097/txd.0000000000001090
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发表时间：
2021-01
影响因子：
2.3
通讯作者：
Stock PG
中科院分区：
文献类型：
--
作者：
Amara D;Wisel SA;Braun HJ;Collisson EA;Friedlander T;Worner G;Roll GR;Hirose R;Stock PG
在患有供体来源的恶性肿瘤的移植患者中停止免疫抑制提供了理论上的益处，即患者免疫系统的重建将允许恶性肿瘤的“排斥”，因为恶性肿瘤也源自同种异体组织。然而，这种选择存在的警告是，患者的同种异体移植物也可能被排斥。在胰肾联合移植（SPK）受者中，正常的持续功能和未受影响的肾脏或胰腺中可能没有恶性肿瘤进一步使这一决定复杂化。详细回顾了3例SPK术后发生供者转移性恶性肿瘤的病例。我们根据成功的结果和对现有文献的回顾提供治疗和管理建议。与广泛的文献综述一致，在所有3例病例中，完全停止免疫抑制，切除两个移植物，1例病例成功使用免疫检查点抑制剂治疗以增强免疫应答。一名患者在成功接受肾再次移植后1年表现良好，而另一名患者在2年内没有转移性疾病的证据后在SPK再次移植的等待名单上活跃。转移性供者源性恶性肿瘤的成功治疗需要同种异体移植物清除、免疫抑制停止和辅助治疗，包括偶尔使用检查点抑制剂以增强免疫应答。
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. 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. 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. 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.