Case report: Donor Malignant Astrocytoma (No transmission via kidney transplants) (1991)

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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: 
No transmission found at two years posttransplant in either of two renal transplant recipients.
Alerting signals, symptoms, evidence of occurrence: 
Donor 43 year old male: Removal "Malignant astrocytoma" (Grade ??), VP-shunt post-operative day 3; died on day 50, then donation (2 kidneys, heart). No report about radiation or chemotherapy. Kidney recipients (2) followed up for 2 years without evidence of transmission. Heart recipient died 7 weeks post transplant, no evidence of malignancy. No transmissions occurred in this case.
Demonstration of imputability or root cause: 
Donor had primary brain tumor (malignant astrocytoma) with ventriculoperitoneal shunt considered to represent elevated risk; prophylactic report without transmission after 2 years.
Groups audience: 
Suggest new keywords: 
Glioblastoma multiforme
Primary brain tumor
Primary central nervous system tumor
Suggest references: 
Delhey, K.; Lewis, R.; Dunn, J.; Berry, J.; Gray, R.; Van Buren, C.; Kahan, B. Absence of tumor transmission from a cadaveric renal donor with malignant astrocytoma and a ventriculoperitoneal shunt--two-year recipient follow-up and review of the literature Transplantation 1991; 52 (4) :737 - 8
Remove "abnormal blood counts, first generation, second generation" from keywords as these are irrelevant. (ok - Evi)
Expert comments for publication: 
Authors note that medulloblastomas are the most common tumors reported to be transmitted after ventriculoperitoneal shunts; less commonly, glioblastomas. As of time of report (1991) only 4 cases of astrocytomas metastasizing via VP shunt had been reported, with the shortest time between shunt and development of metastases being 3 months.