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Kidney Week

Abstract: SA-PO1087

Donor-Derived Large B-Cell Lymphoma After SPK

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Athreya, Akshay, Virginia Commonwealth University, Richmond, Virginia, United States
  • Gupta, Gaurav, Virginia Commonwealth University, Richmond, Virginia, United States
  • Azhar, Ambreen, Virginia Commonwealth University, Richmond, Virginia, United States
  • Kamal, Layla, Virginia Commonwealth University, Richmond, Virginia, United States
  • Muthusamy, Selvaraj, Virginia Commonwealth University, Richmond, Virginia, United States
  • Saeed, Muhammad Irfan, Virginia Commonwealth University, Richmond, Virginia, United States
  • Khan, Aamir, Virginia Commonwealth University, Richmond, Virginia, United States
Introduction

Absolute risk of lymphoma transmission with SOT is unknown.In this unique case,DLBCL was detected after SPK with delayed renal allograft dysfunction with functional pancreas & mate kidney.

Case Description

Recipient was nonsensitized 42-year-old EBV IgG+ type 1 diabetic male.Donor was 39-year-old female with paraplegia due to multiple sclerosis on no treatment.No history of cancer at time of death,no leukocytosis & preprocurement CT abd/chest was normal.Cause of death was cerebellar bleeding.Donor was EBV IgG+, KDPI 31% with negative XM.
Before implantation,a core needle biopsy was performed.LM showed CD20+ atypical lymphocytic infiltrate.The recipient received rATG induction & maintenance FK,MMF & steroids per protocol.A creatinine rise prompted biopsy 2 weeks post transplant.It showed diffuse mononuclear inflammatory tubulointerstitial infiltrate with clusters of atypical cells in interstitium & peritubular capillaries staining diffusely for CD20, Ki67(~50%) & variably for BCL2 & MUM1 indicating DLBCL.Atypical cells in procurement biopsy showed similar pattern.Simultaneous tissue gene expression testing (MMDx) showed AbMR,possibly indicating host vs tumor response.Immunosuppression was withdrawn except steroids.PET scan & peripheral flow cytometry were negative.
Patient underwent allograft pancreatectomy & nephrectomy.Explant pathology showed DLBCL invasion of renal graft & portion of small bowel.Due to risk of microinvasion of tumor,rituximab (weekly *4) was given with serial PET scans & R-CHOP.No other donor derived lymphomas were reported to UNOS from heart,liver,lungs & mate kidney from this donor.

Discussion

Early allograft removal,immunosuppression withdrawal & cancer therapy was offered to the patient to maximize treatment efficacy & confer the best chance of survival in this high risk disease.