Donor-Derived Acute Promyelocytic Leukemia in a Liver-Transplant Recipient

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Abstract
The long-term survival of donor lymphoid cells in recipients of solid-organ transplants or of fetal lymphocytes that cross the placenta and enter the maternal circulation has been established,1-3 but the fate of other hematopoietic progenitors in organ allografts, especially those of the myeloid lineage, is not known. We describe a case in which acute promyelocytic leukemia developed in a recipient of a liver transplant two years after transplantation. The leukemic clone had genetic and phenotypic markers of the donor, a previously healthy 16-year-old boy who died of a head injury. Our findings indicate that leukemic transformation of donor myeloid cells that were resident in the transplanted liver occurred in this patient.