(Case report): Donor colon adenocarcinoma in liver transplant patient (2013)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for colorectal cancer (Council of Europe, 2022): Acceptance of pT1-tumours – see AJCC, 8th edition [18] – Donors with pT1 tumours should only be accepted for organ donation with the utmost caution, and a high transmission risk must be assumed. Patients with higher stages of newly diagnosed, active colorectal cancer should not be accepted for organ donation (unacceptable risk). Colorectal cancer in donor history: The presence of pT1/pT2 (Dukes’ A or B) colorectal carcinoma (infiltration of submucosa/muscularis propria) in the donor without lymph node or distant metastases is assumed to have a low transmission risk after adequate treatment and disease-free survival of > 5 years. Risk increases with stage, and probability of presumed cure has to be taken into account.
Time to detection: 
11 months after OLT
Alerting signals, symptoms, evidence of occurrence: 
Asymptomatic elevation of recipient´s liver enzymes (AST 48 U/l, ALT 106 U/l, AP 199 U/l). Right upper quadrant ultrasound revealed new 5 x 3.8 x 4.1cm heterogeneous area in inferior right liver lobe. Biopsy showed adenocarcinoma, immunohistochemistry was suggestive of colonic primary.
Demonstration of imputability or root cause: 
Microsatellite analysis (nine polymorphic microsatellites) plus locus for the amelogenin gene (which helps to determine the presence of X and Y chromosomes) revealed donor origin of the tumor. The analysis compared specimens of liver adenocarcinoma, uninvolved area of transplanted liver tissue and recipient´s gastric biopsy tissue.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case report
Liver transplant
DNA typing
Microsatellite analysis
Large bowel adenocarcinoma
Colorectal adenocarcinoma
Suggest references: 
Kim B, Woreta T, Chen P-H, Limketkai B, Singer A, Dagher N, et al. Donor-transmitted malignancy in a liver transplant recipient: a case report and review of literature. Dig Dis Sci. Springer US; 2013 May;58(5):1185–90.
Tumor not in adverse occurrence type: please add "Gastrointestinal" - "Large bowel adenocarcinoma" First review done - June 10, 2018 - Kerstin Second review done I think we agreed that "colorectal adenocarcinoma" would be a more intuitive term to use than "large bowel adenocarcinoma", so let's go with colorectal under gastrointestinal. 8/5/18 Mike N --> ok (EP)
Expert comments for publication: 
Donor evaluation before and during organ procurement was not suspicious for any previous or active donor malignancy. The recipient was transplanted for cryptogenic liver cirrhosis and HCC. Follow-up three months after OLT showed normal liver chemistry tests and a CT scan of abdomen and thorax was without signs of recurrent HCC or other malignancies. 11 months after OLT, the donor-transmitted adenocarcinoma was detected and locoregional SIRT therapy (Yttrium99-based selective internal radiation therapy) was initiated. Tumor resection and relisting for liver transplantation was no option due to the rapid growth of the tumor. Despite SIRT, rapid growth of the tumor continued and no further treatment was recommended. The liver recipient passed away 8 months after his initial diagnosis of adenocarcinoma. There is no information about other recipients of the same donor. The authors put emphasis on the challenge to distinguish between recurrent HCC and donor transmitted malignancy. They further discuss the advantages and disadvantages of routine donor autopsy. They conclude that careful donor selection is crucial and should include protocols to screen for malignancies as well as mandatory procedures at the time of organ harvesting to limit tumor transmission.