Novel surveillance and cure of a donor-transmitted lymphoma in a renal allograft recipient.
BACKGROUND
In this report we describe a malignant lymphoma of donor origin inadvertently transplanted into two renal allograft recipients, despite standard comprehensive donor screening. The successful clearance of the tumor from both patients and a novel method of surveillance are detailed.


METHODS
Initial management consisted of withdrawal of immunosuppression to promote rejection of the allograft and the transplanted tumor in both patients, followed by graft removal. Peripheral blood microchimerism was assessed in both recipients using nested polymerase chain reaction to detect the DYZ3 gene on the Y chromosome (donor male, recipients female).


RESULTS
Although microchimerism was detected on day 6 after transplantation and day 1 after explantation, repeat peripheral blood examination at 1, 3, and 6 months after explantation demonstrated no microchimerism. Both patients remain well at 12 months and have been relisted for transplantation.


CONCLUSIONS
Despite inadvertent transplantation of a previously undiagnosed malignancy of donor origin, the recipients' immune response was able to eliminate donor tumor cells after the withdrawal of immunosuppression. Repeated surveillance of peripheral blood from both recipients, using a novel application of the technique of nested polymerase chain reaction to amplify donor DNA, demonstrated no persistence of donor cells, supporting effective eradication of the donor malignancy.
University of Queensland Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Australia.
K A
KA
Herzig
M C
MC
Falk
J R
JR
Jonsson
R A
RA
Axelsen
A D
AD
Griffin
C M
CM
Hawley
R J
RJ
Rigby
R
R
Cobcroft
D L
DL
Nicol
E E
EE
Powell
D W
DW
Johnson
D000368:Aged; D002678:Chimera; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014019:Tissue Donors; D014184:Transplantation, Homologous