title: Acute leukemia, a rare but fatal complication after liver transplantation.
abstract: Little information is available about the risk factors and means to improve the survival rate of acute leukemia in a rare but often fatal complication after liver transplantation (LT). We report the development of AML-M2 in one of the 764 patients who underwent liver transplantation at our center, and review the literature on similar cases. The patient, a 42-year-old man who developed acute leukemia 38 months after liver transplantation, was successfully treated with chemotherapy and has subsequently been in remission. With appropriate adjustment of immunosuppressive agents, he was able to safely benefit from chemotherapy. Only 16 patients with acute leukemia after liver transplantation have been reported, and the mortality rate is extraordinarily high (52.94%, 9/17). More cases of acute leukemia will emerge as the rate of survival after liver transplantation increases. The patient's chromosomal mutation profile, the choice of immunosuppressive agent, and infection by hepatitis virus may be the risk factors for the development of acute leukemia after LT. Our experience suggests that clinicians should adjust the immunosuppressive agents according to the immunosuppressive state of the patient and explore the option of reducing or stopping the medication as long as liver function remains stable. These measures could help reduce the high mortality rate among these patients.
authors.affiliation: Liver Transplant Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, NO.600 TianHe Road, TianHe District, Guangzhou 510630, Guangdong Province, PR China.
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Gen-Shu
authors.initials: GS
authors.lastname: Wang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Zhang
authors.forename: Shu-Hong
authors.initials: SH
authors.lastname: Yi
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Chang-Jie
authors.initials: CJ
authors.lastname: Cai
authors.forename: Min-Qiang
authors.initials: MQ
authors.lastname: Lu
authors.forename: Gui-Hua
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000145:classification / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents