Keratolimbal allograft and tumour transmission

1 October 2017 | Magdalena Popiela | EYE - Cornea, EYE - General

This case report describes tumour transmission from keratolimbal allograft donor to recipient. A 68-year-old woman underwent keratolimbal allograft (KLAL) for limbal stem cell failure from a donor, who died of invasive breast carcinoma that had metastasised to multiple levels of her spine. The recipient received immunosuppression with tacrolimus and mycophenolate mofetil (MM) from three months prior to her KLAL transplant until 44th postoperative month. During follow-up two conjunctival raised lesions appeared adjacent to the KLAL graft, one at month 29 (while on reduced dose of MM alone) and second at month 51 (while off oral immunosuppression). Both lesions were excised and microscopic analysis found cells consistent with those present in the original donor’s breast carcinoma. This is the first published report of malignancy transmission following KLAL transplant, with tumours occurring on the host ocular surface and after oral immunosuppression has been discontinued. KLAL may have a higher associated risk of transmission of malignancy compared to keratoplasty, where risk of malignancy transmission is rare. As result of this case and other unpublished reports of melanoma transmission in KLAL, the Eye Bank Association of America has updated their guidelines stating that donors with history of melanoma or solid cancerous tumours with metastasis are contraindicated for KLAL. A retrospective review of KLAL patients having received donors from patients, who died of metastatic cancers is needed, to further look at rates of transmission of tumour from donor to host.