Donor-derived small cell lung carcinoma in a kidney transplant recipient

BACKGROUND. Transplantation of donor- derived malignancies during organ tra nsplantation fortunately is very rare. Discontinuation of immunosuppressive medications under these circumstances has previously resulted in complete tumor rejection. Ectopic adrenocorticotropic hormone (ACTH) production may result in Cushing syndrome and is not an uncommon paraneoplastic feature of small cell carcinoma of the lung. Theoretically, in the organ transplantat ion setting, the resulting high cortisol levels could suppress a tumor-reje ction immune response. However, to the authors' knowledge, no such a clinic al scenario has been described in the literature published to date. METHODS. A 25-year-old living related kidney transplant recipient presented with Cushing syndrome 32 months after transplantation. The donor had been diagnosed with small cell carcinoma of the lung 22 months earlier. On furth er evaluation, the kidney recipient was diagnosed with donor-derived small cell lung 3 carcinoma of the transplanted kidney. She was found to have ext ensive disease involving the liver and retroperitoneum. Despite discontinua tion of immunosuppressive medications, the disease progressed and cortisol levels remained elevated during 6 weeks of observation. RESULTS. The patient received six cycles of cisplatin and etoposide, which resulted in resolution of her hypercortisolemia and a complete remission of her donor-derived small cell carcinoma. At last follow-up, she was 12 mont hs from completing her therapy and continued in complete remission. CONCLUSIONS. Donor-derived small cell carcinoma and ectopic ACTH production can occur in a patient after kidney transplantation. (C) 2001 American Can cer Society.