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Adverse Occurrence type:
Most recent risk assessment for Lymphoma and Leukemia (Council of Europe, 2016): Active lymphomas, acute and chronic leukemias, and plasmacytomas constitute Unacceptable Risks for organ donation. Potential donors with treated acute leukemia or lymphoma with a definite disease-free interval of 5-10 years can be considered for organ donation with a presumed High Risk for transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Delayed recovery of graft function in kidney recipient number 1, adequate graft function for kidney recipient number 2. Protocol (1 month) kidney biopsy and histological examination disclosed diffuse large B-cell lymphoma of the intravascular type, transplant nephrectomy performed in both cases. Liver recipient with no symptoms but biopsied upon information regarding kidney lymphoma.
Demonstration of imputability or root cause:
Similar histological features of intravascular B cell lymphoma found in both kidney recipients and the postmortem examination of the donor. No malignancy was observed in the liver transplant recipient, who nevertheless received prophylactic chemotherapy. This led to liver enzyme elevation related to hepatitis C virus reactivation, but resolved.
Suggest new keywords:
Dziewanowski K, Drozd R, Parczewski M, Klinke M. et al. (2014). Multiorgan transplantation from a deceased donor with intravascular diffuse large B-cell lymphoma: transmission of the disease and results of treatment. Clin Transplant. 28(10):1080-3
Two kidney recipients combined into one row, this row is redundant and can be removed -not clear on what above note means- MN 9/2/15
Expert comments for publication:
Donor presented with CNS symptoms originally suspected due to autoimmune encephalomeningitis. Lymphoma later diagnosed in donor brain (posttransplant) and likely involved CNS in a secondary fashion. Intravascular B cell lymphoma (also known as angiotropic B cell lymphoma) is an uncommon variant that usually does not have lymphadenopathy. Malignant cells are found within small vessels.