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Abstract: SA-PO843

Meningioma in a Kidney Transplant Recipient a Risk Factor for Primary Central Nervous System Lymphoma

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Akram, Sami M., Loma Linda University, Loma Linda, California, United States
  • Paudel, Sujay Dutta, Loma Linda University, Loma Linda, California, United States
  • Rattanavich, Rungwasee, Loma Linda University, Loma Linda, California, United States
  • Regmi, Surakshya, Loma Linda University, Loma Linda, California, United States
  • Villicana, Rafael, Loma Linda University, Loma Linda, California, United States

Group or Team Name

  • Loma Linda Transplant Institute
Introduction

Calcineurin inhibitor (CNI) neurotoxicity is common; has a wide array of presentation. Compromised blood brain barrier (BBB) is a risk factor. We studied a case of PCNSL in a kidney transplant recipient (KTR) with meningioma in order to bring to awareness of association between meningioma and PCNSL.

Case Description

A 56-year-old female is a deceased donor KTR from 11-years ago by thymoglobulin induction. She develops new left hemiparesis and confusion. She was maintained on Tacrolimus (FK), Mycophenolate (MMF) and Prednisone. FK levels were therapeutic and and serum creatinine was 0.9 mg/dL. Epstein Barr Virus (EBV) and SARS-CoV-2 antigen tests were negative. Computed tomography (CT) of the brain showed a 4.2 x 4.5 x 3.9 cm mass centered in the left lentiform nucleus; midline shift of 1.1cm and a calcified meningioma. CT of the abdomen and pelvis was normal. Brain biopsy was consistent with PCNSL lymphoma. EBV encoded RNA staining was positive. Despite cytoreductive surgery and chemotherapy, PCNSL progressed. Her family elected hospice care.

Discussion

Meningioma is common primary brain tumor with latency period of up to 30 years. A meningioma makes BBB permeable due to neo-angiogenesis at its margins. PCNSL constitute only 1% of Non-Hodgkin Lymphoma (NHL). Yet, PCNSL is 65 times more common in solid organ transplant recipients (SOTR) than in general population and six times more common than Non-Hodgkin’s lymphoma (NHL). Therefore, we posit that PCNSL is a form of neurotoxicity due to persistently high concentration CNI via a permeable BBB. EBV is present in 90% of cases which makes host cell genome vulnerable to neurostructural changes. In our case PCNSL occurred despite therapeutic levels of CNI and despite absence of EBV in the serum. Conclusion: Meningioma related BBB permeability, increases severity of neurotoxicity and therefore, risk of PCNSL in a SOTR. Due to long latency of meningioma, risk of PCNSL can be and should be assessed prior to transplantation.

PCNSL