Sarcomas in organ allograft recipients

Our plain-English summary of Sarcomas in organ allograft recipients, by I. Penn (Transplantation, 1995).

The study

• Author: I. Penn
• Journal: Transplantation
• Published: 1995;60(12):1485-91
• Type of article: Review
• Cited by: 154 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In a review of 8724 de novo malignancies that occurred in 8191 organ allograft recipients sarcomas were 7.4% of cancers. Kaposi's sarcoma (KS) made up 5.7%, and other sarcomas (OS) 1.7% a much higher proportion than in the general population. KS was most common in Arab, black, Italian, Jewish, or Greek patients. In 60% of patients with KS the lesions were confined to the skin and/or oropharynx while 40% involved internal organs and/or lymph nodes. Complete remissions following various treatments occurred in 53% of the former group and 27% of the latter. In both groups 32% and 60% of remissions, respectively, occurred when the only treatment was reduction or cessation of immunosuppressive therapy. However, this treatment caused impaired function or allograft loss from rejection in 22 of 34 kidney recipients. Recurrent KS occurred in 5% of patients in remission when immunosuppressive therapy was resumed. Nine of 114 patients (8%) tested for human immunodeficiency virus were positive. Most OS arose in internal organs or soft tissues. The major types were fibrous histiocytoma (20 patients), leiomyosarcoma (15), fibrosarcoma (12), rhabdomyosarcoma (9), hemangiosarcoma (8), undifferentiated sarcoma (7) and mesothelioma (6). Several unusual features were noted. Remarkably, 10 of 105 (10%) sarcomas occurred adjacent to or in a renal (6) or hepatic (4) allograft. Leiomyosarcomas are rare in children, yet 5 of 15 (33%) occurred in pediatric patients. Three hemangiosarcomas occurred in forearms at sites of arteriovenous fistulas used for pretransplant hemodialysis access. One leiomyosarcoma and one fibrosarcoma occurred in previously irradiated areas. One patient with mesothelioma had a history of asbestos exposure and two others had possible exposure.

In plain English

This article reviewed sarcomas reported to the Cincinnati Transplant Tumor Registry from the fall of 1968 until May 1995. Among 8191 organ transplant recipients who developed 8724 malignancies, 461 patients had sarcomas: 356 had Kaposi's sarcoma and 105 had other sarcomas. When nonmelanoma skin cancers and in situ cervical cancers were left out, sarcomas made up 7.4% of malignancies (Kaposi's sarcoma 5.7%, other sarcomas 1.7%). Complete remission followed treatment in 53% of Kaposi's sarcoma patients whose disease was limited to the skin, conjunctiva or mouth and throat lining, and in 27% of those with internal disease. Kidney function was recorded for 34 kidney recipients after their immunosuppressive drugs were reduced or stopped. Of these, 20 lost their transplanted kidneys to rejection. Six of the 105 other-sarcoma patients had mesothelioma, and 5 of the 6 died. One mesothelioma patient had a history of asbestos exposure and two others had possible exposure. The article does not give fiber types, where in the body the mesotheliomas arose, or details of exposure. The author concluded that prior asbestos exposure may have caused one mesothelioma, and possibly two others.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of cases collected by a transplant tumor registry (case series)
• Who was studied: 8191 organ allograft recipients with 8724 malignancies reported to the Cincinnati Transplant Tumor Registry (fall 1968 to May 1995). Of these, 461 patients had sarcomas: 356 had Kaposi's sarcoma and 105 had other sarcomas. Most were kidney recipients (412); the rest received heart, liver, bone marrow, pancreas, heart-lung or lung transplants.
• Exposure: The main focus was organ transplantation with immunosuppressive drugs (azathioprine- and/or cyclosporine-based regimens, some with ALG or OKT3). Asbestos was mentioned only for the mesothelioma patients: one had a history of asbestos exposure and two had possible exposure. No fiber type, job or dose was given.
• Main results:
  • When nonmelanoma skin cancers and in situ cervical carcinomas were excluded, sarcomas made up 7.4% of all malignancies in the registry: Kaposi's sarcoma 5.7% and other sarcomas 1.7%
  • Among Kaposi's sarcoma patients with nonvisceral disease, 113 (53%) had complete remission after treatment. Among those with visceral disease, 38 of 143 (27%) did.
  • Of 34 kidney recipients with Kaposi's sarcoma whose kidney function was recorded after immunosuppression was reduced or stopped, 20 lost their allografts to rejection, 2 had impaired function and 12 kept stable function
  • Nine of 114 Kaposi's sarcoma patients (8%) tested for HIV were positive
  • Mesothelioma occurred in 6 of the 105 patients with other sarcomas
  • Of the 105 patients with other sarcomas, 46 (44%) died of their sarcomas. Mesothelioma had the highest fatality rate: 5 of 6 patients (83%).
  • In 10 of the 105 patients with other sarcomas (10%), the allograft or the tissue around it was the major site of the tumor
• The authors' conclusion: The author concluded that prior asbestos exposure may have caused one mesothelioma, and possibly two others. The author also suggested that prior radiotherapy may have played a role in two other sarcomas, and speculated that viral infection in these immunosuppressed patients may play a role.

Topics

Medical terms in this study, explained in our Lexicon: Sarcoma, De Novo, Mesothelioma, Asbestos Exposure.

Related studies

• Characteristics of thoracic malignancies that occur after solid-organ transplantation — C. Génébès, L. Brouchet, et al. (2010)
• Nuclear Brachyury Expression Is Consistent in Chordoma, Common in Germ Cell Tumors and Small Cell Carcinomas, and Rare in Other Carcinomas and Sarcomas: An Immunohistochemical Study of 5229 Cases — M. Miettinen, Z. Wang, et al. (2015)
• Epithelioid sarcoma. A clinical and pathologic study of nine cases — H. Santiago, L.K. Feinerman, et al. (1972)
• Soft tissue sarcomas of vulva — I. Davos, M.R. Abell (1976)
• Expression of E-cadherin in bone and soft tissue sarcomas: a possible role in epithelial differentiation — H. Sato, T. Hasegawa, et al. (1999)
• Cellular effects of asbestos and other fibers: correlations with in vivo induction of pleural sarcoma — L.E. Lipkin (1980)

Browse return to medical research.