Development of Mesothelioma in Organ Transplant Recipients: A Comprehensive Study of 10 Cases

Context.—: The development of malignancy after organ transplant has been well recognized as a complication of long-term posttransplant immunosuppression. Although rare cases of mesothelioma have been reported in transplant recipients, a comprehensive review of this malignancy in the context of immune suppression is lacking. Objective.—: To provide a comprehensive review of 10 retrospective mesothelioma cases developed after transplant. Design.—: This retrospective study is composed of 10 mesothelioma cases, collected at multiple institutions following solid organ or bone marrow transplant. Patients' clinicopathologic characteristics, histologic features of tumors, and disease prognosis were investigated. Results.—: All 10 patients were males, with a median age of 64 years at the time of mesothelioma diagnosis (range, 57-77 years). The mesothelioma development followed transplant of the kidney (3), liver (3), heart (2), lung (1), and bone marrow (1), among which the bone marrow and kidney recipients showed longer intervals between transplant and development of mesothelioma. Pleural mesothelioma (9) was more common than peritoneal mesothelioma (1). Subtypes of mesothelioma observed included epithelioid (3), biphasic (3), and sarcomatoid (4). Notably, the incidences of sarcomatoid and biphasic subtypes were higher in transplant patients compared with the general population. No association between any subtype of mesothelioma and organ transplanted was observed. Transplant patients passed away shortly (median survival, 10.5 months) after the development of mesothelioma; epithelioid subtype showed the best prognosis, followed by biphasic and sarcomatoid subtypes. Conclusions.—: Although rare, mesothelioma represents another malignancy occurring in the posttransplant population, emphasizing the importance of immune surveillance in cancer development.