1
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Barten MJ, Fisher AJ, Hertig A. The use of extracorporeal photopheresis in solid organ transplantation-current status and future directions. Am J Transplant 2024; 24:1731-1741. [PMID: 38490642 DOI: 10.1016/j.ajt.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/19/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
Prevention and management of allograft rejection urgently require more effective therapeutic solutions. Current immunosuppressive therapies used in solid organ transplantation, while effective in reducing the risk of acute rejection, are associated with substantial adverse effects. There is, therefore, a need for agents that can provide immunomodulation, supporting graft tolerance, while minimizing the need for immunosuppression. Extracorporeal photopheresis (ECP) is an immunomodulatory therapy currently recommended in international guidelines as an adjunctive treatment for the prevention and management of organ rejection in heart and lung transplantations. This article reviews clinical experience and ongoing research with ECP for organ rejection in heart and lung transplantations, as well as emerging findings in kidney and liver transplantation. ECP, due to its immunomodulatory and immunosuppressive-sparing effects, offers a potential therapeutic option in these settings, particularly in high-risk patients with comorbidities, infectious complications, or malignancies.
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Affiliation(s)
- Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg; University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andrew J Fisher
- Transplant and Regnerative Medicine Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alexandre Hertig
- Department of Nephrology, University Versailles Saint Quentin, Foch Hospital, Suresnes, France
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2
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Liu X, Shen J, Yan H, Hu J, Liao G, Liu D, Zhou S, Zhang J, Liao J, Guo Z, Li Y, Yang S, Li S, Chen H, Guo Y, Li M, Fan L, Li L, Luo P, Zhao M, Liu Y. Posttransplant complications: molecular mechanisms and therapeutic interventions. MedComm (Beijing) 2024; 5:e669. [PMID: 39224537 PMCID: PMC11366828 DOI: 10.1002/mco2.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
Posttransplantation complications pose a major challenge to the long-term survival and quality of life of organ transplant recipients. These complications encompass immune-mediated complications, infectious complications, metabolic complications, and malignancies, with each type influenced by various risk factors and pathological mechanisms. The molecular mechanisms underlying posttransplantation complications involve a complex interplay of immunological, metabolic, and oncogenic processes, including innate and adaptive immune activation, immunosuppressant side effects, and viral reactivation. Here, we provide a comprehensive overview of the clinical features, risk factors, and molecular mechanisms of major posttransplantation complications. We systematically summarize the current understanding of the immunological basis of allograft rejection and graft-versus-host disease, the metabolic dysregulation associated with immunosuppressive agents, and the role of oncogenic viruses in posttransplantation malignancies. Furthermore, we discuss potential prevention and intervention strategies based on these mechanistic insights, highlighting the importance of optimizing immunosuppressive regimens, enhancing infection prophylaxis, and implementing targeted therapies. We also emphasize the need for future research to develop individualized complication control strategies under the guidance of precision medicine, ultimately improving the prognosis and quality of life of transplant recipients.
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Affiliation(s)
- Xiaoyou Liu
- Department of Organ transplantationThe First Affiliated Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Junyi Shen
- Department of OncologyZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Hongyan Yan
- Department of Organ transplantationThe First Affiliated Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Jianmin Hu
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Guorong Liao
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ding Liu
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Song Zhou
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jie Zhang
- Department of Organ transplantationThe First Affiliated Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Jun Liao
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Zefeng Guo
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yuzhu Li
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Siqiang Yang
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Shichao Li
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Hua Chen
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ying Guo
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Min Li
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Lipei Fan
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Liuyang Li
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Peng Luo
- Department of OncologyZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ming Zhao
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yongguang Liu
- Department of Organ transplantationZhujiang HospitalSouthern Medical UniversityGuangzhouChina
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3
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Troise D, Infante B, Mercuri S, Catalano V, Ranieri E, Stallone G. Dendritic Cells: A Bridge between Tolerance Induction and Cancer Development in Transplantation Setting. Biomedicines 2024; 12:1240. [PMID: 38927447 PMCID: PMC11200833 DOI: 10.3390/biomedicines12061240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Dendritic cells (DCs) are a heterogeneous group of antigen-presenting cells crucial for fostering allograft tolerance while simultaneously supporting host defense against infections and cancer. Within the tumor microenvironment, DCs can either mount an immune response against cancer cells or foster immunotolerance, presenting a dual role. In immunocompromised individuals, posttransplant malignancies pose a significant health concern, with DCs serving as vital players in immune responses against cancer cells. Both recipient- and donor-derived DCs play a critical role in the rejection process, infiltrating the transplanted organ and sustaining T-cell responses. The use of immunosuppressive drugs represents the predominant approach to control this immunological barrier in transplanted organs. Evidence has shed light on the immunopharmacology of these drugs and novel strategies for manipulating DCs to promote allograft survival. Therefore, comprehending the mechanisms underlying this intricate microenvironment and the effects of immunosuppressive therapy on DCs is crucial for developing targeted therapies to reduce graft failure rates. This review will delve into the fundamental immunobiology of DCs and provide a detailed exploration of their clinical significance concerning alloimmune responses and posttransplant malignancies.
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Affiliation(s)
- Dario Troise
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Barbara Infante
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Silvia Mercuri
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Valeria Catalano
- Unit of Clinical Pathology, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Elena Ranieri
- Unit of Clinical Pathology, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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4
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Yadav R, El Kossi M, Belal D, Sharma A, Halawa A. Post-transplant malignancy: Focusing on virus-associated etiologies, pathogenesis, evidence-based management algorithms, present status of adoptive immunotherapy and future directions. World J Meta-Anal 2023; 11:317-339. [DOI: 10.13105/wjma.v11.i7.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/23/2023] [Accepted: 10/08/2023] [Indexed: 12/14/2023] Open
Abstract
Modern immunosuppression has led to a decrease in rejection rates and improved survival rates after solid organ transplantation. Increasing the potency of immunosuppression promotes post-transplant viral infections and associated cancers by impairing immune response against viruses and cancer immunoediting. This review reflects the magnitude, etiology and immunological characteristics of various virus-related post-transplant malignancies, emphasizing the need for future research. A multidisciplinary and strategic approach may serve best but overall literature evidence targeting it is sparse. However, the authors attempted to provide a more detailed update of the literature consensus for the prevention, diagnosis, management and surveillance of post-transplant viral infections and associated malignancies, with a focus on the current role of adoptive immunotherapy and the way forward. In order to achieve long-term patient and graft survival as well as superior post-transplant outcomes, collaborative research on holistic care of organ recipients is imperative.
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Affiliation(s)
- Rahul Yadav
- Department of Urology, Kidney Transplant and Robotic Uro-oncology, Tender Palm Super Speciality Hospital, Lucknow 226010, Uttar Pradesh, India
- Department of Urology and Kidney Transplant, Charak Hospital and Research Centre, Lucknow 226003, Uttar Pradesh, India
| | - Mohsen El Kossi
- Department of Nephrology, Doncaster Royal Infirmary, Doncaster DN2 5LT, United Kingdom
| | - Dawlat Belal
- Department of Nephrology and Medicine, Kasr El-Ainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Ajay Sharma
- Department of Transplant Surgery, Royal Liverpool University Hospitals, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S57AU, United Kingdom
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5
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Lu K, Chiu KY. Temporal trends of de novo urological malignancy in renal transplant recipients without a cancer history: A longitudinal cohort study. Clin Transplant 2023; 37:e15047. [PMID: 37306943 DOI: 10.1111/ctr.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The incidence of malignancies after successful kidney transplantation has historically been higher than in the general population, with adverse impact on clinical outcomes. However, uncertainty remains as to which cancers occur at what time points after kidney transplantation. METHODS We conducted a longitudinal cohort study to investigate the temporal trends and topographic patterns of de novo malignancies to optimize surveillance protocols and improve transplant outcome in renal transplant recipients. Measurement of death and cancer events was performed to calculate the cumulative risk of events of interest. RESULTS Between 2000 and 2013, 3169 renal transplant recipients were retrospectively screened; 3035 (96%) of them met eligibility criteria and were evaluated with a follow-up of 27612 person-years. There was suboptimal overall survival and malignancy-free survival in renal transplant recipients compared to reference groups (HR: 1.65; 95% CI: 1.50-1.82; p < .001; HR: 2.33; 95% CI: 2.04-2.66; p < .001, respectively). Among renal transplant recipients, urological malignancies were predominant (57.5%), followed by digestive tract malignancies (21.4%). The cancer risks of the urinary bladder and upper urinary tract were lower in male subjects (HR: .48; 95% CI: .33-.72; p < .001; HR: .34; 95% CI: .20-.59; p < .001, respectively). The temporal trends of urological malignancies among renal transplant recipients were expressed in a bimodal pattern, with M-shaped peaks at 3 and 9 years, with gender disparity. CONCLUSIONS In renal transplant recipients, cancer occurrences are shown as M-shaped twin peaks. Our study highlights that specific customized 'targeted' strategies for cancer surveillance programs are required to optimize posttransplant care.
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Affiliation(s)
- Kevin Lu
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Kun-Yuan Chiu
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Puli, Nantou, Taiwan
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6
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Tammisetti VS, Prasad SR, Dasyam N, Menias CO, Katabathina V. Immunosuppressive Therapy in Solid Organ Transplantation: Primer for Radiologists and Potential Complications. Radiol Clin North Am 2023; 61:913-932. [PMID: 37495297 DOI: 10.1016/j.rcl.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The availability of effective immunosuppressive medication is primarily responsible for the dramatic improvement in long-term graft survival rates after solid organ transplantation. The commonly used drugs include monoclonal/polyclonal antibodies, corticosteroids, calcineurin inhibitors (cyclosporine and tacrolimus), antimetabolites, mammalian target of rapamycin, and many novel drugs. Prolonged immunosuppression is accompanied by several well-described potentially life-threatening complications. In addition to drug-related side effects, recipients of solid organs are unavoidably at a higher risk for infections and malignancies. Select infections and malignancies in solid organ transplant patients have distinctive imaging findings, and radiologists play a crucial role in the timely diagnosis and management of these conditions.
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Affiliation(s)
| | - Srinivasa R Prasad
- Department of Radiology, University of Texas M. D. Anderson Cancer Center
| | - Navya Dasyam
- Department of Radiology, University of Pittsburgh Medical Center
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7
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Ng WHS, Curchin DJ, McGinn S, Smith SD. Outcomes in organ transplants from donors with melanoma: a systematic review. Int J Dermatol 2023; 62:1121-1130. [PMID: 37537648 DOI: 10.1111/ijd.16797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Melanoma transmitted through organ transplantation is an increasingly reported event. Immunosuppression increases the risk of melanoma; however, transmission of malignancy from transplanted organs is a distinct etiology of melanoma occurrence. The risk of transmission of melanoma from an organ donor with melanoma has yet to be determined. The authors aimed to investigate this phenomenon by reviewing the outcomes of patients that received organs from donors with melanoma. A systematic literature review was conducted with emphasis on identifying organ donors with known histories of melanoma and reported information regarding recipients of their organs. The databases PubMed, MEDLINE, Embase, and JBI EBP were searched in January 2023. Search terms included "melanoma," terms for solid organs, "donor," "transplant," "transmission," and their variations as well as terms related to temporal relations. Inclusion criteria were articles that stated outcomes in organ recipients from donors that had a diagnosis of melanoma either pretransplant or postmortem. Reference lists of selected articles were hand searched for further studies. A total of 232 articles were identified from the search parameters. After applying inclusion and exclusion criteria, 13 articles were selected. Hand searching the references of these articles yielded four additional articles. Of the 75 organ recipients that received organs from donors with known melanoma, 43 developed melanoma. While a definitive quantitative risk cannot be ascertained based on our review, the numerous reported cases of melanoma in organ recipients from donors that have melanoma should still be considered by clinicians.
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Affiliation(s)
| | - David John Curchin
- The Westmead Clinical School, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
| | - Stella McGinn
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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8
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Carney BW, Larson MC, Corwin MT, Lamba R. Imaging of Hepatobiliary Cancer. Curr Probl Cancer 2023:100964. [PMID: 37321910 DOI: 10.1016/j.currproblcancer.2023.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
The liver and biliary tree are common sites of primary and secondary malignancies. MRI followed by CT is the mainstay for the imaging characterization of these malignancies with the dynamically acquired contrast enhanced phases being the most important for diagnosis. The liver imaging reporting and data system classification provides a useful framework for reporting lesions in patents with underlying cirrhosis or who are at high risk for developing hepatocellular carcinoma. Detection of metastases is improved with the use of liver specific MRI contrast agents and diffusion weighted sequences. Aside from hepatocellular carcinoma, which is often diagnosed noninvasively, other primary hepatobiliary tumors may require biopsy for definite diagnosis, especially when presenting with nonclassic imaging findings. In this review, we examine the imaging findings of common and less common hepatobiliary tumors.
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Affiliation(s)
- Benjamin W Carney
- Department of Radiology, University of California, Davis Health System, Sacramento, California.
| | - Michael C Larson
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Michael T Corwin
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Ramit Lamba
- Department of Radiology, University of California, Davis Health System, Sacramento, California
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9
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Rudym D, Natalini JG, Trindade AJ. Listing Dilemmas: Age, Frailty, Weight, Preexisting Cancers, and Systemic Diseases. Clin Chest Med 2023; 44:35-46. [PMID: 36774166 DOI: 10.1016/j.ccm.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Selection of lung transplant candidates is an evolving field that pushes the boundaries of what is considered the norm. Given the continually changing demographics of the typical lung transplant recipient as well as the growing list of risk factors that predispose patients to poor posttransplant outcomes, we explore the dilemmas in lung transplant candidate selections pertaining to older age, frailty, low and high body mass index, preexisting cancers, and systemic autoimmune rheumatic diseases.
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Affiliation(s)
- Darya Rudym
- Division of Pulmonary and Critical Care Medicine, New York University, Langone Health, 530 First Avenue, HCC-4A, New York, NY 10016, USA.
| | - Jake G Natalini
- Division of Pulmonary and Critical Care Medicine, New York University, Langone Health, 530 First Avenue, HCC-4A, New York, NY 10016, USA
| | - Anil J Trindade
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Oxford House, Room 539, 1313 21st Avenue South, Nashville, TN 37232, USA
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10
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Kaposi Sarcoma in a Child after Fanconi Anemia-Induced Haploidentical Hematopoietic Stem Cell Transplant: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020188. [PMID: 36832317 PMCID: PMC9954514 DOI: 10.3390/children10020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/01/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Kaposi sarcoma is relatively common after solid organ transplantation, but very rare after hematopoietic stem cell transplant (HSCT). Here we are reporting a rare case of Kaposi sarcoma in a child after HSCT. An 11-year-old boy with Fanconi anemia was treated by haploidentical HSCT from his father. Three weeks after transplantation, the patient developed severe graft-versus-host disease (GVHD) which was treated by immunosuppressive therapy and extracorporeal photopheresis. Approximately 6.5 months after HSCT, the patient had asymptomatic nodular skin lesions over the scalp, chest, and face. Histopathological examination showed typical findings of Kaposi sarcoma. Later, additional lesions in the liver and oral cavity were confirmed. Liver biopsy was positive for HHV-8 antibodies. The patient was continued on Sirolimus which was already being used for the treatment of GVHD. Cutaneous lesions were also treated with topical timolol 0.5% ophthalmic solution. Within six months, cutaneous and mucous membrane lesions were completely resolved. Follow-up abdominal ultrasound and MRI showed the disappearance of the hepatic lesion.
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11
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Soliman M, Guys N, Liu P, Moshiri M, Menias CO, Mellnick VM, Savas H, Badawy M, Elsayes KM, Gaballah AH. Multimodality imaging findings of infection-induced tumors. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3930-3953. [PMID: 36069914 DOI: 10.1007/s00261-022-03651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
Several infections can predispose to certain malignancies in different body parts. These infections include viral, bacterial, and fungal pathogens. Imaging plays a vital role in the diagnosis, staging, and management of these neoplastic conditions. Furthermore, it can help in differentiating infection-related non-neoplastic processes that can mimic malignancies. Both radiologists and clinicians should be familiar with these conditions. This review discusses the epidemiology, pathogenesis, and imaging features of infection-related tumors.
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Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas Guys
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Moshiri
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, Columbia, MO, USA.
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12
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Chacko SR, Matta A, Bhat R, Minimo C, Benzaquen S, Gupta E. A 62-Year-Old Immunocompromised Man With Halo Sign on Chest Imaging. Chest 2022; 162:e177-e181. [DOI: 10.1016/j.chest.2022.04.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/27/2022] [Accepted: 04/23/2022] [Indexed: 11/05/2022] Open
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13
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Brookmeyer CE, Bhatt S, Fishman EK, Sheth S. Multimodality Imaging after Liver Transplant: Top 10 Important Complications. Radiographics 2022; 42:702-721. [PMID: 35245104 DOI: 10.1148/rg.210108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients who have undergone liver transplant are now regularly seen in day-to-day radiology practice. All surgical techniques for liver transplant require arterial, portal venous, hepatic venous and caval, and biliary anastomoses. This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. Arterial complications are the most common and devastating. Early hepatic artery thrombosis may be catastrophic because the biliary tree is solely dependent on the hepatic artery after transplant and collateral vessels have not yet formed. In contrast, delayed hepatic artery thrombosis may be more insidious as collateral arteries develop. US findings of delayed hepatic artery thrombosis may be similar to those of hepatic artery stenosis and celiac artery stenosis. Splenic artery steal syndrome is an increasingly recognized cause of graft ischemia. Venous complications are much less common. Hepatic venous and caval complications are notable for their increased incidence in living-donor and pediatric transplants. Biliary complications often result from arterial ischemia. Biliary cast syndrome is a notable example in which ischemic biliary mucosa sloughs into and obstructs the duct lumens. Neoplasms also may occur within the hepatic graft and may be due to recurrent malignancy, posttransplant lymphoproliferative disorder, or metastases. US is the initial imaging modality of choice, particularly in the acute postoperative setting. Further evaluation with contrast-enhanced US, CT, or MRI; catheter angiography; endoscopic retrograde cholangiopancreatography; and/or nuclear medicine studies is performed as needed. An invited commentary by Bhargava is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Claire E Brookmeyer
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Shweta Bhatt
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Elliot K Fishman
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Sheila Sheth
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
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14
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Mahíllo B, Martín S, Molano E, Navarro A, Castro P, Pont T, Andrés A, Galán J, López M, Oliver E, Martínez A, Mosteiro F, Roque R, Pérez-Redondo M, Cid-Cumplido M, Ballesteros MA, Daga D, Quindós B, Sancho M, Royo-Villanova M, Bernabé E, Muñoz R, Chacón JI, Coll E, Domínguez-Gil B. Malignancies in Deceased Organ Donors: The Spanish Experience. Transplantation 2022; 106:1814-1823. [DOI: 10.1097/tp.0000000000004117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Robinson C, Chanchlani R, Kitchlu A. Malignancies after pediatric solid organ transplantation. Pediatr Nephrol 2021; 36:2279-2291. [PMID: 33057766 DOI: 10.1007/s00467-020-04790-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022]
Abstract
As life expectancy among pediatric solid organ transplant recipients (SOTRs) improves, the risk of comorbid conditions such as malignancy post-transplantation has also increased. SOTRs are at elevated risks of post-transplantation lymphoproliferative disorders (PTLDs), and skin and solid cancers. PTLDs typically occur early following transplantation, while skin and solid cancers frequently arise in young adulthood (25-40 years). By 30 years following transplantation, 26-41% of pediatric SOTRs have developed cancer. Different risk factors exist for PTLD, and skin and solid cancers, which are modified by cumulative immunosuppression, infections, transplanted organ, and the underlying disease process associated with initial organ failure (e.g., kidney failure). Optimal cancer treatment strategies depend on the specific cancer type, stage, and patient comorbidities. Immunosuppression reduction may be beneficial for certain cancers but must be considered against the risks of acute and chronic rejection and allograft loss. Lifestyle counseling regarding smoking avoidance and sun protection, as well as human papillomavirus vaccination, is an important aspect of cancer prevention. Currently, no cancer screening guidelines exist specifically for pediatric SOTRs. Adult population screening guidelines have not been validated in transplant populations. Therefore, an individualized approach should be taken to cancer screening for pediatric SOTRs, accounting for other cancer risk factors.
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Affiliation(s)
- Cal Robinson
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES McMaster, Hamilton, Ontario, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, 8 Eaton North, 8 N-842, Toronto, Ontario, M5G 2C4, Canada.
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16
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Ghonge NP, Goyal N, Vohra S, Chowdhury V. Renal transplant evaluation: multimodality imaging of post-transplant complications. Br J Radiol 2021; 94:20201253. [PMID: 34233470 DOI: 10.1259/bjr.20201253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive "one-stop" modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist"s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Nidhi Goyal
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Veena Chowdhury
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
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17
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Beeckmans H, Bos S, Vos R. Selection Criteria for Lung Transplantation: Controversies and New Developments. Semin Respir Crit Care Med 2021; 42:329-345. [PMID: 34030197 DOI: 10.1055/s-0041-1728756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lung transplantation is an accepted therapeutic option for end-stage lung diseases. The imbalance between limited availability and vast need of donor organs necessitates careful selection of recipient candidates, ensuring the best possible utilization of the scarce resource of organs. Nonetheless, possible lung transplant candidates who could experience a meaningful improvement in survival and quality of life should not be excluded solely based on the complexity of their case. In this review, controversial issues or difficult limitations for lung transplantation, and new developments in recipient selection criteria, are discussed, which may help broaden recipient eligibility for lung transplantation without compromising long-term outcomes.
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Affiliation(s)
- Hanne Beeckmans
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Bos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), BREATHE, Leuven, Belgium
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18
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Story MT, Sanders ML, Bashir AA, Longo JM, Abel SL, Dollard SC, Grodstein EI, Thomas CP, Katz DA. Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C-positive organ transplantation. Transpl Infect Dis 2021; 23:e13481. [PMID: 33012057 DOI: 10.1111/tid.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
Kaposi sarcoma (KS) following kidney transplantation can result from recipient reactivation of latent human herpesvirus 8 (HHV-8) infection or activation of donor-acquired HHV-8 infection. Post-transplant KS typically manifests with cutaneous pathology, but rare cases of renal allograft involvement have been reported. We describe two cases of donor-derived HHV-8 infection in two hepatitis C (HCV) viremia-negative transplant recipients who each received a kidney from a donor with HCV viremia. One recipient did not develop KS while the other presented with acute kidney injury caused by extensive KS infiltration of the renal parenchyma and metastatic disease. This report reviews the literature for cases of KS involving the renal allograft and highlights an unexpected consequence of deliberate HCV-positive organ transplantation.
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Affiliation(s)
- Maria T Story
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - M Lee Sanders
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Amani A Bashir
- Department of Pathology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Jude M Longo
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Radiology, University of Iowa Roy and Lucille Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Stacy L Abel
- Iowa City VA Health Care System, Iowa City, IA, USA
| | | | - Elliot I Grodstein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christie P Thomas
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Daniel A Katz
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Surgery, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
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19
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Guan C, Shi Y, Liu J, Yang Y, Zhang Q, Lu Z, Zheng G, Ye W, Xue M, Zhou X, Zhang N, Li H, Xie R, Chen B, Lu P. Pulmonary involvement in acquired immunodeficiency syndrome-associated Kaposi's sarcoma: a descriptive analysis of thin-section manifestations in 29 patients. Quant Imaging Med Surg 2021; 11:714-724. [PMID: 33532271 DOI: 10.21037/qims-20-284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (AIDS-KS) was the first malignant neoplasm to be described as being related to AIDS. The lungs are the most common visceral site of AIDS-KS. This study aimed to analyze the computed tomography (CT) manifestations of pulmonary involvement in AIDS-KS. Methods Twenty-nine male patients were enrolled in this retrospective study. Imaging evaluation parameters included lesion distribution, the flame sign, interlobular septal thickening, peribronchovascular interstitium thickening, ground-glass opacity (GGO), dilated blood vessels in lesions, and pleural effusion. Results A peribronchovascular distribution was observed in all patients, predominantly in the lower lobes. Of the patients, 58.62% (17/29) exhibited the flame sign, 75.86% (22/29) had interlobular septal thickening, 72.41% (21/29) had peribronchovascular interstitium thickening, 82.76% (24/29) had GGO, and 34.48% (10/29) had pleural effusion. Enlarged lymph nodes with a short-axis diameter >1.0 cm were found in 41.38% (12/29) of the patients. Of the 12 patients who underwent contrast-enhanced CT (CECT), 90.91% (11/12) had dilated blood vessels, and nodules, consolidations, and lymph nodes were observed to be strongly enhanced. Intrapulmonary lesions decreased in size or number after appropriate treatment during follow-up. Conclusions Common CT manifestations of pulmonary AIDS-KS include the flame sign, peribronchovascular distribution, peribronchovascular interstitium thickening, interlobular septa thickening, GGO, dilated blood vessel, and strong enhancement of nodules, consolidations, and lymph nodes. It is helpful to follow up the therapeutic effect of pulmonary AIDS-KS by chest CT.
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Affiliation(s)
- Chunshuang Guan
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuxin Yang
- Department of Radiology, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qianqian Zhang
- Department of Radiology, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiyan Lu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guangping Zheng
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Wen Ye
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Ming Xue
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xingang Zhou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Na Zhang
- Department of Radiology, Chengdu Public Health Clinical Center, Chengdu, China
| | - Hongjun Li
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Ruming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Budong Chen
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Puxuan Lu
- Department of Radiology, Shenzhen Center for Chronic Disease Control, Shenzhen, China
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20
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Fenoglio R, Roccatello D, De Simone E, Del Vecchio G, Ferro M, Quattrocchio G, Barreca A, Sciascia S. The Challenging Management of Cancer: An Immunonephrologist's Perspective. Kidney Blood Press Res 2020; 46:114-120. [PMID: 33326976 DOI: 10.1159/000511256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Onconephrology is an emerging medical subspecialization that focuses on the numberless interrelations between cancer and kidney diseases. Tumor cells evade immune surveillance through activation of immune checkpoint pathways that suppress antitumor immune responses. By blocking checkpoints, new anticancer agents disrupt immune homeostasis but potentially induce immune-mediated diseases. Nephrologists and nephroimmunologists should be able to treat the nephrotoxic sequelae of cancer therapy and ensure continuation of the life-saving treatment. METHODS Thirty-seven renal biopsies have been carried out over 42 months in oncologic patients, that is, 5.2% of the total native renal biopsies were carried out in the same period. The commonest diagnoses (>6 cases) were interstitial tubular nephritis, membranous glomerulopathy, IgA nephropathy, vasculitis, and focal and segmental glomerulosclerosis. CASE PRESENTATION Three example cases, including focusing on key questions which could involve the nephrologists are reported in detail. They include a cancer-related Goodpasture Syndrome, the peculiar toxic effects of pemetrexed on tubular cells, and the intriguing relationship between bevacizumab and cryoglobulinemic glomerulonephritis. CONCLUSION As shown by these 3 example cases, nephrologists need to be open-minded with regard to kidney biopsy in order to get a timely diagnosis. Nephrologists also need to improve their knowledge of cancer biology and therapy in order to prevent kidney problems, manage therapy-related immune-mediated disorders, and improve patient life expectancy.
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Affiliation(s)
- Roberta Fenoglio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy,
| | - Emanuele De Simone
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giulio Del Vecchio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Michela Ferro
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giacomo Quattrocchio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Antonella Barreca
- Division of Pathology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Savino Sciascia
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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21
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Turshudzhyan A. Post-renal transplant malignancies: Opportunities for prevention and early screening. Cancer Treat Res Commun 2020; 26:100283. [PMID: 33338850 DOI: 10.1016/j.ctarc.2020.100283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/18/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
GOAL OF THE REVIEW While transplant recipients are aware of increased malignancy risk, there is little consensus on the preventative measures. The goal of this review is to bring available preventative measures to light and prompt more research to be done with ultimate goal of developing an individualized prevention plan for each patient based on risk factors and available screening tools. INTRODUCTION Transplant surgery offers patients with end-stage renal disease a longer life expectancy with help of immunosuppressive therapies. Nonetheless, life-long immunosuppression comes at a cost of post-renal transplant malignancies, which have become the leading cause of morbidity in this patient group. DISCUSSION Post-renal transplant cancers can develop through either de novo, by donor-related transmission, or recurrence of recipient's pre-transplant cancer. While immunosuppressive therapy is considered to be the leading cause, weakened immunosurveillance of neoplastic cells and inadequate immune response against oncogenic viruses also plays an important role. The most common cancers seen in renal transplant patients are skin cancers and post-transplant lymphoproliferative disorder (PTLD). Risk factors for skin cancers have are ultraviolet light, human papilloma virus infection, and use of cyclosporin and azathioprine. Numerous viral infections have been associated with transplant-related malignancies post-transplant. CONCLUSION While lowering of immunosuppressive therapy remains the treatment of choice, it may lead to graft failure. Given some of the presented malignancies have modifiable risk factors and options for screening, clinical outcomes can be improved. Limiting skin exposure, dermatologic screening, and prophylactic retinoids can help lower the incidence rate of skin malignancy. Endoscopic screening for renal transplant patients can help identify gastric adenocarcinoma early and improve survival rates. Some of the post-transplant malignancies have been responsive to anti-viral treatment.
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Affiliation(s)
- Alla Turshudzhyan
- University of Connecticut, Internal Medicine, 263 Farmington Avenue, Farmington, CT 06030-1235.
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22
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Bujo C, Amiya E, Hatano M, Tsuji M, Maki H, Ishida J, Ishii S, Narita K, Endo M, Ando M, Shimada S, Kinoshita O, Ono M, Komuro I. Association between infectious event and de novo malignancy after heart transplantation. Heart Vessels 2020; 36:499-508. [PMID: 33140148 DOI: 10.1007/s00380-020-01715-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
The aim of the study was to investigate the incidence of and risk factors for de novo malignancy after heart transplantation (HTx) in a single center. We assessed 102 consecutive patients who received HTx and were followed-up in our center regularly for > 1 year from June 2006 to May 2018. We investigated the incidence of and risk factors for de novo malignancy. The cumulative incidence of each malignancy type during the follow-up period was one (0.98%) for skin cancer, four (3.92%) for nonskin solid organ cancer, and six (5.88%) for posttransplant lymphoproliferative disorder (PTLD). The percentage of patients with more than one infectious event ≤ 1 year after HTx was higher in the malignancy group than in the non-malignancy group. Furthermore, Kaplan-Meier analysis revealed that the incidence rate of infectious events was higher in patients with malignancies than in those without (log-rank P < 0.001). After dividing malignancies into a PTLD group and a solid organ malignancy group, we found that negative Epstein-Barr virus serostatus, cytomegalovirus-positive antigenemia, and the occurrence of any viral or gastrointestinal infectious event at ≤ 1 year were more frequent in patients with PTLD than in patients without it. The survival rate was significantly lower for patients with solid organ malignancy than for patients without malignancy. In conclusion, there was a correlation between infectious events and de novo malignancy, particularly in patients with PTLD. We should confirm this finding by conducting a larger cohort study.
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Affiliation(s)
- Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Ishii
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Miyoko Endo
- Departmant of Nursing, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
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23
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Wasnik AP, Aslam AA, Millet JD, Pandya A, Bude RO. Multimodality imaging of pancreas-kidney transplants. Clin Imaging 2020; 69:185-195. [PMID: 32866771 DOI: 10.1016/j.clinimag.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Simultaneous pancreas-kidney transplant remains a treatment option for patients with insulin-dependent diabetes mellitus type 1, aimed at restoring normoglycemia, alleviating insulin dependency, avoiding diabetic nephropathy, and thereby improving the quality of life. Imaging remains critical in the assessment of these transplant grafts. Ultrasound with Doppler remains the primary imaging modality for establishing baseline assessment of the graft as well as for evaluating vascular, parenchymal, and perigraft complications. Noncontrast MR imaging is preferred over non-contrast CT for evaluation of parenchymal or perigraft complications in patients with decreased renal function, although contrast-enhanced CT/MR imaging may be obtained following multidisciplinary consultation in cases with high clinical and laboratory suspicion for graft dysfunction. Catheter angiography is reserved primarily for therapeutic intervention in suspected or confirmed vascular complications. An understanding of the surgical techniques and imaging appearance of a normal graft is crucial to identify potential complications and direct timely management. This article provides an overview of surgical techniques, normal imaging appearance, as well as the spectrum of imaging findings and potential complications in pancreas-kidney transplants.
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Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Anum A Aslam
- Department of Radiology, University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - John D Millet
- Department of Radiology, University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Amit Pandya
- Department of Radiology, University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Ronald O Bude
- Department of Radiology, University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
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24
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Kim S, Rovgaliyev B, Lee JM, Lee KW, Hong SK, Cho JH, Yoon KC, Yi NJ, Suh KS. Clinical Significance of De Novo Malignancy After Liver Transplant: A Single-Center Study. Transplant Proc 2020; 53:200-206. [PMID: 32409224 DOI: 10.1016/j.transproceed.2020.02.148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have reported that solid organ transplant recipients have a high risk for malignant tumors because the suppressed immune system fails in preventing malignant transformations. De novo malignancy after transplantation is the most common cause of death in the late period after liver transplant (LT). This study investigated the clinical significance of de novo malignancy after LT, and it is the largest study based in Korea to report long-term follow-up results associated with de novo malignancy after LT. METHODS Data of 1793 adults who underwent LT in Seoul National University Hospital were retrospectively collected, and medical charts and data from the Ministry of Public Administration and Security were reviewed to examine the causes of death and de novo malignancy status. The Fisher exact test and Kaplan-Meier survival analysis were used to analyze the data. RESULTS Of the 1793 recipients, 27 died of de novo malignancies. Of 875 hepatocellular carcinoma (HCC) patients, 12 died, and of 918 non-HCC patients, 15 died. De novo malignancy was the main cause of death at 5 years after LT but was not in the initial 5 years. In Korea the most common cancers that developed after LT were gastric cancer (21.4%) and lymphoma (14.3%). De novo HCC in non-HCC cases was found in 2 patients. CONCLUSION De novo malignancy is a key factor affecting long-term survival after LT. Therefore, regular screening and education are important for improving long-term survival and quality of life in these patients after LT.
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Affiliation(s)
- Sara Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Berik Rovgaliyev
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hyung Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Chul Yoon
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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25
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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Liu J, Shen L, Huang H, Gao X, Mou S, Ying L, Yin T. A rare case of donor-derived promyelocytic sarcoma in a kidney transplant recipient. Ann Hematol 2020; 100:295-296. [PMID: 32270214 DOI: 10.1007/s00277-020-04013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jiaying Liu
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Lijing Shen
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Honghui Huang
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Xiao Gao
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Shan Mou
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Liang Ying
- Nephrotransplantation Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Tingyu Yin
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
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Abstract
Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2nd most common cause of death 5–10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
OBJECTIVE. Imaging plays an important role in the diagnosis and staging of malignancies. Many common lymphoproliferative and other solid tumor malignancies can be viral-related. CONCLUSION. This review discusses the imaging findings that can be associated with common viral-induced malignancies. Knowledge of these imaging presentations can help narrow the differential diagnosis to reach a specific diagnosis through a precise workup and proper management.
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Cajanding R. Immunosuppression following organ transplantation. Part 2: complications and their management. ACTA ACUST UNITED AC 2019; 27:1059-1065. [PMID: 30281349 DOI: 10.12968/bjon.2018.27.18.1059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in the care of patients who have had a solid organ transplant has led to a growing population of post-transplant patients, who are also living for longer. As a result of their longer life expectancy, transplant recipients often face a multitude of challenges, including optimising their immunosuppressive regimens and managing potential complications. Life-threatening infections, malignancies, and organ-specific toxicities are the complications post-transplant patients commonly encounter and these complications are often associated with increased morbidity and mortality, adverse graft functioning and survival, profound impairment in the patient's quality of life, and significant healthcare burden. This article, the second of two parts, gives an overview of the issues involved in the care of patients who are receiving immunosuppressants. The common complications encountered by post-transplant patients are discussed and their assessment, management, prevention and treatment explored.
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Affiliation(s)
- Ruff Cajanding
- Staff Nurse, Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
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30
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Preventive Role of mTOR Inhibitor in Post-Kidney Transplant Urothelial Carcinoma. Transplant Proc 2019; 51:2731-2734. [PMID: 31447189 DOI: 10.1016/j.transproceed.2019.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little evidence about whether mammalian target of rapamycin (mTOR) inhibitor could prevent post-kidney transplant (KT) urothelial carcinoma (UC) or not. The aim of this study is to analyze the role of mTOR inhibitor add-on in tacrolimus-based kidney transplant recipients. METHOD The data were obtained from the Kaohsiung Chang Gung Memorial Hospital using the Chang Gung Research Database and retrospectively reviewed from January 2000 to December 2015. Patients then were categorized into 2 groups: group FK (more than 2-year tacrolimus [FK] prescription) and group FK + mTOR inhibitor (more than 2-year tacrolimus plus at least 6-month continued sirolimus prescription). The primary end point is post-KT UC development. The secondary end point is mTOR inhibitor add-on effect on renal function deterioration episode. RESULTS There were 140 patients with tacrolimus-based immunosuppressant (group FK) and 82 patients with tacrolimus-based and add-on mTOR inhibitor regimen (group FK + mTOR inhibitor). The follow-up duration, sex distribution, and combined mycophenolate mofetil rate are similar in both groups. Younger age, lower tacrolimus trough level, lower UC incidence, and longer KT-to-UC interval were observed. Short- to intermediate-term results revealed noninferior graft outcome by creatinine level or creatinine deterioration. CONCLUSIONS In our preliminary result, mTOR inhibitor add-on in patients with tacrolimus-based regimen revealed less post-KT UC occurrence. In addition, noninferior graft outcome was also observed. In Taiwan, a high UC prevalence area, mTOR inhibitor add-on strategy can be considered as a preventive strategy for UC after KT.
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31
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Pfeifer JD. Identity determination in diagnostic surgical pathology. Semin Diagn Pathol 2019; 36:355-365. [PMID: 31196743 DOI: 10.1053/j.semdp.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
From a technical perspective, specimen identity determination in surgical pathology over the last several decades has primarily focused on analysis of repetitive DNA sequences, specifically microsatellite repeats. However, a number of techniques have recently been developed that have similar, if not greater, utility in surgical pathology, most notably analysis of single nucleotide polymorphism (SNPs) and gene panels by next generation sequencing (NGS). For cases with an extremely limited sample or a degraded sample, sequence analysis of mitochondrial DNA continues to be the method of choice. From a diagnostic perspective, interest in identity determination in surgical pathology is usually centered on resolving issues of specimen provenance due to specimen labeling/accessioning deficiencies and possible contamination, but is also frequently performed in cases for which the patient's clinical course following definitive therapy is remarkably atypical, in cases of an unexpected diagnosis, and by patient request for "peace of mind". However, the methods used for identity determination have a much broader range of applications in surgical pathology beyond tissue provenance analysis. The methods can be used to provide ancillary information for cases in which the histomorphology is not definitively diagnostic, as for example for tumors that have a virtually identical microscopic appearance but for which the differential diagnosis includes synchronous/metachronous tumors versus a metastasis, and for the diagnosis of hydropic early gestations versus hydatidiform molar pregnancies. The methods also have utility in several other clinical settings, for example to rule out a donor-transmitted malignancy in a transplant recipient, to monitor bone marrow transplant engraftment, and to evaluate natural chimerism.
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Affiliation(s)
- John D Pfeifer
- Department of Pathology, Washington University School of Medicine, Campus Box 8118, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
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32
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Wang PW, Wu TH, Pan TL, Chen MH, Goto S, Chen CL. Integrated Proteome and Cytokine Profiles Reveal Ceruloplasmin Eliciting Liver Allograft Tolerance via Antioxidant Cascades. Front Immunol 2018; 9:2216. [PMID: 30319655 PMCID: PMC6168655 DOI: 10.3389/fimmu.2018.02216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022] Open
Abstract
Acute rejection (AR) and spontaneous tolerance may occur after allograft orthotopic liver transplants (OLT) performed in certain combinations of donor and recipient rat strains, yet the underlying molecular cascades involved in these conditions remain poorly understood. Comprehensive analysis with proteomic tools revealed that ceruloplasmin was highly expressed during the tolerant period on day 63 post-OLT (POD 63) compared to the rejected samples on POD 14. Meanwhile, cytokine expression profiles implied that the inflammation was significantly stimulated in the AR subjects. Again, protein carbonylation was dramatically upregulated in the rejected subject within the tolerant group. Knockdown of ceruloplasmin would elicit more severe ROS damage, leading to cell death in the presence of H2O2, which induced Nrf2 cascade and the recovery of ceruloplasmin to mediate spontaneous tolerance. In summary, ceruloplasmin may contribute to amending the oxidative stress that eventually causes cell apoptosis and to maintaining the survival of hepatocytes in a drug-free tolerance OLT model.
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Affiliation(s)
- Pei-Wen Wang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Tung-Ho Wu
- Division of Cardiovascular Surgery, Veterans General Hospital, Kaohsiung, Taiwan
| | - Tai-Long Pan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shigeru Goto
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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33
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Zambrano Mendoza E, Yen CT, Takahashi TK, Prado GF, Balancin ML, de Castro G. Metastatic Lung Adenocarcinoma Harboring an EGFR-Activating Mutation in a Heart Transplant Recipient. J Glob Oncol 2018; 4:1-4. [PMID: 30241181 PMCID: PMC6180757 DOI: 10.1200/jgo.17.00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elizabeth Zambrano Mendoza
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
| | - Cheng Tzu Yen
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
| | - Tiago Kenji Takahashi
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
| | - Gustavo Faibischew Prado
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
| | - Marcelo Luiz Balancin
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
| | - Gilberto de Castro
- Elizabeth Zambrano Mendoza, Cheng Tzu Yen, Tiago Kenji Takahashi, Gustavo Faibischew Prado, and Gilberto de Castro Jr, Instituto do Câncer do Estado de São Paulo and Universidade de São Paulo; Cheng Tzu Yen and Gilberto de Castro Jr, Hospital Sírio Libanês; and Marcelo Luiz Balancin, Diagnóstika, São Paulo, Brazil
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Juszczak H, Lowenstein SE, Crow L, Roll GR, McCalmont TH, Arron ST. Potential for overlooked melanoma in solid organ donors with a severely dysplastic nevus. JAAD Case Rep 2018; 4:682-683. [PMID: 30112454 PMCID: PMC6092521 DOI: 10.1016/j.jdcr.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hailey Juszczak
- School of Medicine, University of California, San Francisco, California
| | | | - Lauren Crow
- Department of Dermatology, University of California, San Francisco, California
| | - Garrett R Roll
- Department of Surgery, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, California
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35
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Babey H, Quéré G, Descourt R, Le Calloch R, Lanfranco L, Nousbaum JB, Cornec D, Tison A, Chouaid C. Immune-checkpoint inhibitors to treat cancers in specific immunocompromised populations: a critical review. Expert Rev Anticancer Ther 2018; 18:981-989. [PMID: 29995451 DOI: 10.1080/14737140.2018.1499468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Because of their efficacy against numerous cancers, immune-checkpoint inhibitors (ICIs), anti-cytotoxic T-lymphocyte antigen-4, and anti-programmed cell death monoclonal antibodies are being used ever more often in oncology. However, some patients were excluded from clinical trials because of their comorbidities despite their potentially higher cancer frequencies, as is the case for immunocompromised patients. Areas covered: We analyzed reported preclinical and clinical information and evaluated the risk/benefit ratio for four immunocompromised populations: people living with human immunodeficiency virus (PLHs), solid-organ transplant recipients, recipients of hematopoietic stem-cell allografts, and patients with autoimmune diseases. Expert commentary: Information available in the literature is fragmentary and scarce, making it difficult to evaluate the risk/benefit ratio. It can, nonetheless, be noted that ICI use in PLHs seems possible. For solid-organ transplant recipients, the risk for the graft seems elevated. For the other two populations, it is difficult to conclude at this time.
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Affiliation(s)
- Hélène Babey
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Gilles Quéré
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Renaud Descourt
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Ronan Le Calloch
- b Service des maladies du sang, médecine interne, maladies infectieuses (MIIS) , Centre Hospitalier de Quimper Cornouaille , Quimper , France.,c Université de Brest , Fédération Inter Hospitalier d'Immuno-Hématologie de Bretagne Occidentale (FIHBO) , Brest , France
| | - Luca Lanfranco
- d Service de néphrologie , Centre Hospitalier Universitaire de Brest , Brest , France.,e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France
| | - Jean-Baptiste Nousbaum
- f Service d'Hépato-gastroentérologie , Centre Hospitalier Universitaire de Brest , Brest , France.,g Registre Finistérien des Tumeurs Digestives, EA 7479 SPURBO , Université de Bretagne Occidentale , Brest , France
| | - Divi Cornec
- e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France.,h Rhumatologie et Centre National de Référence des Maladies Auto-Immunes Rares CERAINO , CHRU de Brest , Brest , France
| | - Alice Tison
- e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France.,h Rhumatologie et Centre National de Référence des Maladies Auto-Immunes Rares CERAINO , CHRU de Brest , Brest , France
| | - Christos Chouaid
- i Service de pneumologie , Centre Hospitalier Intercommunal de Créteil , Créteil , France
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Karakoyun M, Önen Ş, Baran M, Çakır M, Ecevit ÇÖ, Kılıç M, Kantar M, Aksoylar S, Özgenç F, Aydoğdu S. Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:89-93. [PMID: 29391313 PMCID: PMC6322611 DOI: 10.5152/tjg.2017.17089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS A liver transplant is the preferred treatment for patients with end-stage liver disease, as it usually results in longterm survival. However, due to the use of chronic immunosuppressive therapy, which is necessary to prevent rejection, de novo cancer is a major risk after transplantation. The aim of this study was to assess the incidence of post-transplant malignancies in children after liver transplantations. MATERIALS AND METHODS The study group consisted of 206 liver transplant recipients, with no history of cancer, including hepatocellular carcinoma, in two liver transplantation centers in Turkey between 1997 and 2015. Data were obtained from patient's data chart. RESULTS In the study group, de novo cancer was diagnosed in 13 of the 206 patients. Post-transplant lymphoproliferative disease (PTLD) occurred in seven (53.8%) patients and other malignancies in six of the 13 patients. The types of PTLD were as follows: B-cell origin (n=2), Epstein-Barr virus (EBV)-related (n=2), T-cell origin (n=1), and Hodgkin's lymphoma (n=2). EBV DNA was isolated from seven patients, three of whom developed PTLD. The others developed Kaposi's sarcomas, Burkitt's lymphomas, cutaneous large-cell lymphomas, Hodgkin's lymphomas, and liver sarcomas. CONCLUSION After transplantation, immunosuppressive treatment is unavoidable, increasing the risk of malignancies. However, a close follow-up and periodic screening can reduce cancer-related mortality and morbidity.
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Affiliation(s)
- Miray Karakoyun
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Şebnem Önen
- Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Maşallah Baran
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Katip Celebi University School of Medicine, İzmir, Turkey
| | - Murat Çakır
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karadeniz Technical University School of Medicine, Trabzon Turkey
| | - Çiğdem Ömür Ecevit
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Prof. Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Murat Kılıç
- Department of Transplantation and General Surgery, Kent Hospital, İzmir, Turkey
| | - Mehmet Kantar
- Department of Pediatric Oncology, Ege University School of Medicine, İzmir, Turkey
| | - Serap Aksoylar
- Department of Pediatric Oncology, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, İzmir, Turkey
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