Adult T-cell leukemia in a liver transplant recipient that did not progress after onset of graft rejection.
A liver allograft recipient developed acute-type adult T-cell leukemia (ATL) during tacrolimus treatment, 2 years after undergoing transplantation for subacute fulminant hepatitis. Both donor and recipient were asymptomatic carriers of human T-cell lymphotropic virus type I (HTLV-I), but the ATL cells originated from the recipient. Tacrolimus treatment was discontinued, and combination chemotherapy was administered. The patient achieved complete remission, but the transplanted liver was acutely and chronically rejected. The patient did not respond to rescue therapy with tacrolimus, prednisolone, and mycophenolate mofetil and died of hepatic failure. Liver biopsies showed CD4+ ATL cell infiltration at the onset of ATL but not at the terminal stage. Moreover, Southern blotting revealed clonal integration of HTLV-I into the host genome of lymphoma cells at onset but not at the terminal stage. ATL after liver transplantation has not been previously described. The clinical course of the posttransplantational ATL was atypical, because it did not progress after the onset of rejection.
Suzuki
Shinsuke
S
Department of Haematology, Kagoshima University Hospital, Kagoshima, Japan. suzuki2@m.kufm.kagoshima-u.ac.jp
Uozumi
Kimiharu
K
Maeda
Masahiko
M
Yamasuji
Yoshiko
Y
Hashimoto
Shin-ichi
S
Komorizono
Yasuji
Y
Owatari
Satsuki
S
Tokunaga
Masahito
M
Haraguchi
Kouichi
K
Arima
Naomichi
N
D017809:Fatal Outcome; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D006505:Hepatitis / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy / Q000209:etiology*; D017114:Liver Failure, Acute / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous