Status:
Ready to upload
Record number:
1882
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for Lung Cancer (Council of Europe, 2022): Any histotype of newly-diagnosed lung cancer is an unacceptable risk for organ donation. Lung cancer in the donor history: Treated lung cancer is considered to be associated with a high transmission risk. Risk may decrease after curative therapy, with recurrence-free time and with increasing probability of cure.
Time to detection:
5.5 years
Alerting signals, symptoms, evidence of occurrence:
Male recipient received double lung transplantation at the age of 17. Donor was a 56-year-old woman with no relevant medical and no smoking history. Five years after transplant, he presented with decreased lung function which was associated with a rhinovirus infection and improved after methylprednisolon. Six months later, the patient had a decreased lung function again. A CT scan showed PET positive enlarged mediastinal lymph nodes. Biopsy revealed metastases of a poorly differentiated carcinoma which could be specified as lung adenocarcinoma by immunohistochemistry. The lung itself showed no significant lesions but re-evaluation of the CT scan showed a PET positive infiltration/atelectasis in the right lower lobe which earlier was thought to be caused by Pseudomonas aeruginosa infection. One month after diagnosis the patient developed carcinomatous pleuritis on the right side, which was treated with pleurodesis. In this stage IV disease (KRAS mutation, no EGFR mutation), chemotherapy was not given because of expected complications in combination with immunosuppressive therapy.
Demonstration of imputability or root cause:
FISH confirmed the donor origin of the tumor (2X-chromosomes, no Y-chromosome), additional PCR demonstrated 11/15 different Short Tandem Repeats (STR) and amelogenin in the lymph node biopsies with tumor compared to the DNA of the recipient.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Lung transplant
FISH
DNA typing
lung cancer, adenocarcinoma
NSCLC (non-small-cell lung carcinoma)
Case report
Reference attachment:
Suggest references:
de Boer M, Vink A, van de Graaf EA. Non-small cell lung carcinoma of donor origin after bilateral lung transplantation. Lung cancer (Amsterdam, Netherlands). 2012;76(2):259-61.
Note:
First review done 2018-09-08 (Kerstin)
Second review 9/11/18 Mike
Expert comments for publication:
Tumor occurrence 5 years after transplant in the highly immunosuppressed lung recipient suggests a de novo lung tumor of the graft rather than a transmission of a pre-existing donor tumor at the time of transplant.