Case report: Glioblastoma multiforme (Astrocytoma, Grade IV), Lung transplant (2009)

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Record number: 
1571
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for astrocytoma and glioblastoma (Council of Europe, 2022): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extraneural metastases from low-grade astrocytomas (WHO grade II) are rare and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors, the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of transformation into a more aggressive malignancy can be ruled out. Since astrocytomas tend to relapse with a histologically higher grade of malignancy, new histological examinations to regrade the tumour should be performed where relapse occurs. If the tumour co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high-grade and will be associated with an increased risk of transmission. Spontaneous extraneural metastases of anaplastic astrocytomas and glioblastoma are rare, but such metastases have been observed, and seem to occur more frequently when associated with prior surgical treatment and/or ¬ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma (WHO grade IV) are considered intermediate to high risk for transmission, depending on different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ¬ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection: 
N/A
Alerting signals, symptoms, evidence of occurrence: 
Donor had Glioblastoma multiforme with surgery 4 months ago+chemotherapy+radiotherapy. After chest-CT without evidence for pathology double lung transplant performed on critically ill patient. No tumor identified with 20 month followup.
Demonstration of imputability or root cause: 
Prophylactic observation of donor with GBM detected before recovery - risk benefit assessment.
Groups audience: 
Suggest new keywords: 
GBM (glioblastoma multiforme), CNS neoplasia
Glioma risk benefit assessment before transplantation
Suggest references: 
Chen, F.; Karolak, W.; Cypel, M.; Keshavjee, S.; Pierre, A. Intermediate-term outcome in lung transplantation from a donor with glioblastoma multiforme J Heart Lung Transplant 2009; 28 (10) :1116 - 8
Expert comments for publication: 
Authors critically remark on proper workup of donor and risk benefit assessment of recipient. Other cases in Discussion: Donor with GBM with lymph node metastasis found at time of donation; transplant proceeded; Lung, liver and kidney recipients all died with GBM several months after transplant.