Novel surveillance and cure of a donor-transmitted lymphoma in a renal allograft recipient

Background. In this report we describe a malignant lymphoma of donor origin inadvertently transplanted into two renal allograft recipients, despite st andard comprehensive donor screening, The successful clearance of the tumor from both patients and a novel method of surveillance are detailed. Methods. Initial management consisted of withdrawal of immunosuppression to promote rejection of the allograft and the transplanted tumor in both pati ents, followed by graft removal. Peripheral blood microchimerism was assess ed in both recipients using nested polymerase chain reaction to detect the DYZ3 gene on the Y chromosome (donor male, recipients female). Results. Although microchimerism was detected on day 6 after transplantatio n and day 1 after explantation, repeat peripheral blood examination at 1, 3 , and 6 months after explantation demonstrated no microchimerism, Both pati ents remain well at 12 months and have been relisted for transplantation. Conclusion. Despite inadvertent transplantation of a previously undiagnosed malignancy of donor origin, the recipients' immune response was able to el iminate donor tumor cells after the withdrawal of immunosuppression. Repeat ed surveillance of peripheral blood from both recipients, using a novel app lication of the technique of nested polymerase chain reaction to amplify do nor DNA, demonstrated no persistence of donor cells, supporting effective e radication of the donor malignancy.