Ask the Experts - Donor-Transmitted Hairy Cell Leukemia?
I transplanted a kidney from a 26-year-old male who died as a result of head and abdominal trauma sustained in a motor vehicle accident. Splenic injury required a splenectomy. It was prospectively found from splenic histology and flow cytometry that the donor had hairy cell leukemia (or splenic marginal cell lymphoma). The recipient has excellent allograft function. How should I follow up prospectively?
Pradip Chakrabarti, MD
There are little data available on the natural history of donor-transmitted hairy cell leukemia. That being said, I would recommend the option of allograftnephrectomy in this patient since the kidney is not an immediately life-saving organ transplant. If the patient decides to keep the kidney, I would enlist the assistance of a hematologist/oncologist to determine whether there are any markers or noninvasive tests that one can perform as surveillance monitoring for the development of hairy cell leukemia in the recipient. Alternatively, one may need to resort to invasive tests (ie, bone marrow biopsy) to follow this patient.