Status:
Ready to upload
Record number:
1889
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for sarcoma (Council of Europe, 2022):
Due to the very aggressive behavior of sarcoma, they are considered an unacceptable risk for organ donation at any stage of disease. Sarcoma in donor history: Because of the very aggressive behavior of sarcoma, they are mostly considered an unacceptable risk for organ donation. After curative treatment and a recurrence-free survival of > 5 years, sarcomas are still assumed to be associated with a high risk for transmission.
Time to detection:
At donor autopsy, directly after procurement. Liver and left lung had already been transplanted.
Alerting signals, symptoms, evidence of occurrence:
During organ procurement, the 48-year-old female donor´s ascending aorta showed lesions which appeared to be severe atherosclerosis. Malignancy was not suspected. All thoracic and abdominal visceral organs including the spleen were macroscopically unremarkable. Liver and lungs were transplanted. The heart has not been transplanted due to the presumed atherosclerosis the right lung has not been transplanted due to excessive secretions. Both allocated kidneys showed small renal cell carcinoma at time of preparation in the recipient center and were not implanted.
Donor autopsy then revealed the aortic lesions to be an intraluminal spindle cell sarcoma (which additionally involved the brachiocephalic, left common carotid and left subclavian arteries). It also showed multiple microscopic sarcoma metastases in the spleen. Urgent liver and lung retransplant (from the same donor) were performed 4 days later. In the pathologic examination, a 0.9 cm metastasis of sarconatous origin was discovered deep in the first transplanted liver. After 76 months of post-transplant follow-up, the liver recipient was without any sign of cancer.
The case of the lung recipient has been published separately after 24 months of disease-free follow-up (Kreisel D, Engels FH, Krupnick AS et al. Transplantation 2001), the recipient was still free of cancer after 76 months of follow-up according to personal communication between the authors of both papers.
Demonstration of imputability or root cause:
Histologic diagnosis of a previously undected donor tumor at donor autopsy.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
References:
Suggest new keywords:
malignancy
case report
liver transplant
Histologic analysis
Sarcoma
Reference attachment:
Suggest references:
Ortiz JA, Manzarbeitia C, Noto KA, Rothstein KD, Araya VA, Munoz SJ, et al. Extended survival by urgent liver retransplantation after using a first graft with metastasis from initially unrecognized donor sarcoma. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2005;5(6):1559-61.
Note:
First review done August 5, 2018 (Kerstin)
Notes to the Notify team:
1. please add Keyword "spindle cell sarcoma", thanks! --> ok (EP)
2. if not already included, we should add the mentioned reference to our review list (Kreisel D, Engels FH, Krupnick AS et al. Emergent lung retransplantation after discovery of two Primary malignancies in the donor. Transplantation 2001; 71:1859-62) --> ok (EP)
2nd Review Carl-Ludwig: Full agreement, please add key wird & Upload Second reference
Expert comments for publication:
Urgent retransplantation in cases of a high transmission risk of post-transplant detected donor malignancy can prevent malignancy transmission. Indication for retransplant is depending upon the time interval between transplantation and tumor diagnosis and also upon recipient findings (in cases of a longer time interval after transplant). Decision should be made after interdisciplinary discussion and involvement of the recipient, if possible.