@article {4979,
	title = {Metastatic donor-derived malignancies following simultaneous pancreas-kidney transplant: three case reports and management strategies},
	volume = {7},
	year = {2020},
	month = {Dec},
	pages = {e636},
	abstract = {Abstract
Stopping immunosuppression in a transplant patient with donor-derived malignancy offers the theoretical benefit that reconstitution of the patient{\textquoteright}s immune system will allow "rejection" of the malignancy, as the malignancy also originates from allogeneic tissue. However, this option exists with the caveat that the patient{\textquoteright}s allograft(s) will likely be rejected too. In simultaneous pancreas-kidney (SPK) recipients, the normal continued functioning and possible absence of malignancy in either the unaffected kidney or pancreas further complicate this decision.

Methods: The charts of 3 patients with donor-derived metastatic malignancies after SPK were retrospectively reviewed in detail. We provide treatment and management recommendations based on successful outcomes and a review of the existing literature.

Results: Consistent with a broad review of the literature, in all 3 cases, complete immunosuppression cessation, removal of both grafts, and in 1 case treatment with an immune checkpoint inhibitor to augment the immune response was successful. One patient is doing well 1 year after successfully undergoing kidney retransplantation, while a second patient is active on the waitlist for SPK retransplantation after no evidence of metastatic disease for 2 years.

Conclusion: The successful management of metastatic donor-derived malignancies requires allograft removal, immunosuppression cessation, and adjuvant therapy that includes occasional use of checkpoint inhibitors to augment the immune response.},
	doi = {10.1097/TXD.0000000000001090},
	author = {Amara, D and Wisel, SA and Braun, HJ and Collisson Friedlander, T and Worner, G and Roll, GR and Hirose, R and Stock, PG}
}
