Jonas S, Bechstein W O, Lemmens H P, Neuhaus R, Thalmann U, Neuhaus P
Department of Surgery, Virchow Clinic, Humboldt University, Berlin, Germany.
Transpl Int. 1996;9(4):426-9. doi: 10.1007/BF00335707.
The transmission of donor-related malignancies by organ transplantation is a rather rare event. There has only been one report on the development of a brain tumor metastasis in liver transplantation. From September 1988 to January 1993, 342 donor hepatectomies with subsequent transplantation were performed at our center. The main donor diagnoses included subarachnoidal bleeding (n = 128; 37.4%), isolated head injury (n = 114; 33.3%), multiple injuries (n = 55; 16.1%), primary cerebral neoplasia (n = 13; 3.8%), and other (n = 32; 9.4%). Primary cerebral neoplasia included glioblastoma (n = 4), meningioma (n = 3), astrocytoma (n = 2), angioma (n = 2), neurocytoma (n = 1), and ependymoma (n = 1). In the group of donors suffering from primary cerebral neoplasia, procured organs other than the liver included kidneys (n = 20), combined kidneys and pancreata (n = 1), pancreata (n = 2), hearts (n = 8), combined hearts and lungs (n = 1), and single lungs (n = 1). Follow-up of the respective graft recipients ranged from 28 to 68 months (median 43 months). Recurrent malignancy was observed once, in a liver graft recipient. The donor, a 48-year-old female, had undergone surgical resection of an intracerebral multiform glioblastoma and died 4 months later of a relapse in the brain stem. The 28-year-old female recipient had undergone transplantation for an autoimmune-hepatitic cirrhosis. Four months later, histopathological examination of an intraperitoneal and intrahepatic mass revealed a poorly differentiated, small-cell pleomorphic cancer, identified as a glioma metastasis by S100- and glial fibrillary acidic protein immunohistochemical staining. The patient died 6 months post-transplantation. On autopsy, no further neoplastic lesions were detected. Our review adds a second reported case of a liver graft-transmitted brain tumor to the literature and the fourth donor-related malignancy after hepatic transplantation in general.
通过器官移植传播供体相关恶性肿瘤是一种相当罕见的事件。关于肝移植中发生脑肿瘤转移仅有一份报告。1988年9月至1993年1月，我们中心进行了342例供体肝切除并随后进行移植手术。主要的供体诊断包括蛛网膜下腔出血（n = 128；37.4%）、单纯头部损伤（n = 114；33.3%）、多发伤（n = 55；16.1%）、原发性脑肿瘤（n = 13；3.8%）以及其他（n = 32；9.4%）。原发性脑肿瘤包括胶质母细胞瘤（n = 4）、脑膜瘤（n = 3）、星形细胞瘤（n = 2）、血管瘤（n = 2）、神经细胞瘤（n = 1）和室管膜瘤（n = 1）。在患有原发性脑肿瘤的供体组中，除肝脏外获取的器官包括肾脏（n = 20）、肾胰联合器官（n = 1）、胰腺（n = 2）、心脏（n = 8）、心肺联合器官（n = 1）和单肺（n = 1）。各自的移植受者随访时间为28至68个月（中位时间43个月）。在一名肝移植受者中观察到一次复发性恶性肿瘤。供体是一名48岁女性，曾接受脑内多形性胶质母细胞瘤的手术切除，4个月后死于脑干复发。28岁的女性受者因自身免疫性肝硬化接受了移植手术。4个月后，对腹腔和肝内肿块进行组织病理学检查发现一个低分化的小细胞多形性癌，通过S100和胶质纤维酸性蛋白免疫组化染色确定为胶质瘤转移。该患者在移植后6个月死亡。尸检未发现其他肿瘤病变。我们的综述为文献增添了第二例报告的肝移植传播脑肿瘤病例，总体上也是肝移植后第四例供体相关恶性肿瘤病例。
