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Adverse Occurrence type:
Estimates Frequency:
Most recent risk assessment for breast cancer (Council of Europe, 2018):
newly diagnosed breast cancer represents an unacceptable risk for organ donation.
Organs from donors with a history of breast cancer might be accepted in selected cases after full treatment, complete remission, stringent follow-up for at least 5 years depending on the initial stage, hormone receptor and Her2/neu expression, always bearing in mind the risk of transmission due to possible late metastases.
Breast cancer stage 1 (AJCC, 8th edition 2016) with curative surgery and cancer-free period > 5 years seems to be associated with a low to intermediate risk for transmission.
All other breast cancer stages are considered high risk for transmission independent of the presumed recurrence-free survival and treatment.
Alerting signals, symptoms, evidence of occurrence :
Lung recipient (first patient to develop tumor): Chest X-ray performed during allograft dysfunction showed mediastinal lymphadenopathy, biopsy showed tumor;
Left kidney recipient: CT performed after being informed of lung recipient status was negative for tumor, 5 years later patient devleoped hypercalcemia, malaise and weight loss, CT showed multiple liver lesions and biopsy showed tumor;
Right kidney recipient: Screening performed after being informed of lung recipient status was negative for tumor, several months later a biopsy performed for nephrotic range proteinuria thought due to antibody mediated rejection showed tumor, with masses confirmed by CT.
Liver recipient: Alerting signs not listed; tumor detected in liver graft and biopsy showed carcinoma.
MPHO Type:
Time to detection:
Double lung recipient: 16 mo; Left kidney recipient: 6 years 1 mo; Liver recipient: 4 years 5 months; Right kidney recipient: 4 years 3 months; Liver recipient:
Demonstration of imputability or root cause:
The ER+/PR+ tumor in the lung recipient was shown to be of donor origin by DNA microsatellite analysis; tumors in all other recipients were also ER+/PR+ except for the liver recipient, in which only the ER is listed and is positive.
Imputability grade:
3 Definite/Certain/Proven
Reference attachment:
Note:
Please clone record for lung and liver recipients (I listed kidney transplant in this record)
Also, I think we should split the breast cancer category into "Breast cancer, not further specified" and "Breast cancer, other". The not further specified category would include the "garden variety" ductal and lobular cancers, ie the breasst carcinomas, whereas the other would include rare types such as sarcomas. Leading off with the word "other" suggests that we are listing unusual tumors only in this category, in my opinion.
Suggest new keywords :
Case report
Deceased donor
Kidney transplant
Liver transplant
Lung transplant
DNA typing
Microsatellite analysis
Breast cancer, other or type not specified
Breast cancer, not further specified
Suggest references:
Matser YAH, Terpstra ML, Nadalin S, Nossent GD, de Boer J, van Bemmel BC, et al. Transmission of breast cancer by a single multiorgan donor to 4 transplant recipients. Am J Transplant. 2018;18(7):1810-4.