14.4.1 Suspected transmission malignancy

Clinical manifestations of transmitted malignancies may be variable depending on the type of tumour considered. In the context of solid organ transplantation, the identification of a malignancy in the transplanted organ, with or without extra graft involvement, should raise the suspicion of a transmitted malignancy. However, some reports have described a different clinical picture where the transmitted malignant tumour does not involve the allograft itself.

Temporal sequence should be reasonable according to the tumour type under study. Most transmitted tumours appear within the first 14 months after transplantation. Therefore, it is unlikely that an aggressive tumour diagnosed in the recipient 5 years after transplantation is donor-transmitted.

A previous description of the transmission may help support the suspicion. A correct assessment of a case involves the analysis of the literature in order to understand whether the same tumour type has been transmitted before. Registry reports and case reports provide information regarding the type of transmission and the methodology followed for the assessment of attributability.