LOGO CASE REPORTCASE REPORT Transmission of breast cancer by a single multiorgan donor to 4 transplant recipients Literatures Source American journal of transplantation Yvette A. H. Matser1 |?Matty L. Terpstra2 |?Silvio Nadalin3 |?George D. Nossent4 |Jan de Boer5 |?Barbara C. van Bemmel6 |?Susanne van Eeden7 |?Klemens Budde8 |Susanne Brakemeier8 |?Frederike J. Bemelman2Author IF:6.4932 1、、 INTRODUCTION This case report describes the transmission of breast cancer from a single organ donor to 4 recipients many years after donation. At the time of donation, it was unknown that the donor suffered from a malignancy.32、CASE REPORT The 53-year-old donor in this case had no relevant medical history and donated her kidneys, lungs, liver. The other 4 recipients developed donor-derived breast cancer (proven by DNA microsatellite) within 16 months to 6 years after transplantation. Unfortunately, the double-lung recipient, left-kidney recipient, and liver recipient died due to the donor-derived breast cancer. The right-kidney recipient remains alive. After the diagnosis of breast cancer in the transplanted kidney, the patient underwent transplant nephrectomy, his immunosuppression was stopped, chemotherapy was initiated, and he achieved complete remission despite widely metastasized disease. FIGURE?1 15①①、、Double-lung recipientDouble-lung recipient The lungs were allocated to a 42-year-old female who suffered from end-stage lung disease due to sarcoidosis with remitting pneumothoraces. In August 2008 (16 months after transplantation), the patient was admitted to the hospital because of transplant dys function. A chest X-ray showed mediastinal lymphadenopathy. A mediastinal lymph node biopsy showed estrogen receptor and progesterone-receptor positive (ER+, PR+) adenocarcinoma. The FES-PET scan revealed abnormalities in the lungs and bones. The patient’s immunosuppression was reduced. In September, a CT scan showed lesions in the liver and bones that were compatible with metastases. Six months later, she presented with increasing thoracic pain, hypercalcemia, and renalinsufficiency. In August 2009, palliative care was started, and after a few days, the patient passed away. Extensive research with 5 independent DNA microsatellite markers revealed that this breast cancer was donor derived.6②②、、Left-kidney recipienLeft-kidney recipien The left-kidney recipient was a 62-year-old female. She underwent a postmortem donor kidney transplantation in April 2007 under highly urgent status because of an imminent lack of vascular access, which was limiting dialysis options. When Eurotransplant reported the death of the lung recipient in 2010 due to donor-derived metastatic breast cancer, the situation was discussed with the patient. It seemed that removal of the transplant was not an option because of a lack of access. A CT scan of the transplanted kidney was performed, which major pathology. Prophylactic antihormonal treatment was considered. However, because there were no data in the literature supporting this treatment, it was finally decided not to start antihormonal drugs. Five years later, the patient presented with hypercalcemia, weight loss, and malaise. A CT scan of the abdomen showed multiple lesions in the liver. A liver biopsy revealed ER+, PR+ adenocarcinoma, which appeared to have spread to the kidney, liver, bone.7③③、、Liver recipient The liver graft was allocated to a 59-year-old female recipient suf?fering?from?decompensated?primary?biliary?cirrhosis.?Four?years?later?(in 2011), a tumor was detected in segment VIII of the liver graft and histologically proven to be donor-derived metastasized ER+ breast cancer. A retransplantation was immediately proposed to the recipient, which she refused. She felt well and was afraid of potential postoperative complications she had experienced in 2007 after the liver transplantation. She decided to undergo an ablative procedure by means of extracorporeal proton radiation at another center, and there were radiological signs of complete response. After a long-term stable disease, in 2014 (7 years after the transplant), the patient developed extrahepatic tumor progression that was mainly localized at the hilar region. She refused any further oncological treatment and died a few months later due to diffuse tumor progression.④④、、Right-kidney recipient A 32-year-old male received the right kidney. After he was informed of the transmission of breast cancer to the lung recipient in 2010, regular tumor screening investigations were performed, including achest X-ray and ultrasound of the abdomen. In addition, a CT scan of the chest was performed in January 2011. All of the findings were unremarkable. In July 2011, the patient developed massive proteinuria (3 g/d), and antibody-mediated rejection was suspected due to weak HLA-class II antibodies. A biopsy showed widespread invasion of the renal allograft by ER+, PR+ adenocarcinoma, which appeared to be human epidermal growth factor receptor 2 positive. A CT scan of the transplanted kidney revealed several focal hypodense areas and a heterogeneous cortex.94、、?DISCUSSION It's not the first time that a cancer has metastasized between an organ donor and an organ recipient, but the odds of that happening are very low, somewhere between 1 in 10, 000 and 5 in 10, 000, and in this case, it's the first time a donor has transferred cancer cells to four receptors. Why would a person who shows no signs of cancer "infect" organ recipients after an organ transplant? Why do patients with different organs have the same kind of cancer? At present, the researchers have only some speculation about the cause, the definitive reason is unknown. One hypothesis is that donor breast cancer has metastasized or metastasized in every transplant organ, and previous studies have shown that circulating tumor cells were found in the first stage of breast cancer. Recipients of organ transplants require long-term use of immunosuppressants, which allow cancer cells in organs that do not normally develop. Another possible reason is that ischemia-reperfusion injury associated with organ transplantation may stimulate the expression of tumor cells.105、、summary At present, for organ transplanters, what they can do is to have regular physical examination. Once the "metastatic" cancer appears, they should try to remove the transplanted organs, remove the immune suppression, and conduct active cancer treatment.LOGO。