Status:
Ready to upload
Record number:
1894
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2022):
No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended, and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. Urothelial cancer in the donor history: Strict follow-up must have been provided after primary diagnosis because these tumours may be multicentric and tend to recur, with a need for repeated cystoscopy and TUR-B, and for restaging. Kidney transplantation will be associated with increased risk, but this has not been classified in the literature yet. After a disease-free interval > 5 years, the transmission risk of invasive urothelial cancer will depend on the probability of cure and must be assessed individually before accepting a potential organ donor. No specific recommendations are available from the literature.
Time to detection:
3 months
Alerting signals, symptoms, evidence of occurrence:
21-year-old kidney recipient with episodes of gross hematuria starting 3 months after transplant. The first episode was well explained by an arteriovenous fistula which was treated by endovascular embolization. The second life-threatening episode occurred a month later and was accompanied by fever which led to a chest x-ray. This revealed a bilateral interstitial infiltrate (no dyspnea) and the following CT scan showed a random distribution of micro- and macronodules in both lungs which enhanced over the next 21 days. Biopsy showed only necrotic tissue. 7 months after transplant, allograft nephrectomy was performed due to another episode of gross hematuria and histopathology revealed high-grade urothelial carcinoma. A few days later the patient had hemoptysis and an open lung biopsy confirmed lung metastases. Despite cessation of the immunosuppression and chemotherapy with paclitaxel, the patient died one month later of large parietal hemorrhage.
The recipient of the liver was checked after the tumor was found in the kidney recipient and showed liver nodules in ultrasonography which were confirmed to be of tumoral etiology in biopsy. No further Information is described in this paper.
The second kidney recipient had no sign of neoplasm transmission.
Demonstration of imputability or root cause:
One kidney and the liver recipient of the same donor were confirmed to have metastases of urothelial carcinoma. The second kidney recipient had no evidence of tumor transmission at the time of case publication.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
malignancy
case report
kidney transplant
kidney and urinary tract
urothelial (transitional) cell carcinoma
Liver transplant
Reference attachment:
Suggest references:
Ferreira GF, de Oliveira RA, Jorge LB, Nahas WC, Saldanha LB, Ianhez LE, et al. Urothelial carcinoma transmission via kidney transplantation. Nephrology Dialysis Transplantation. 2010;25(2):641-3.
Note:
Second review 9/26 Mike: I agree, please clone this record and in the cloned record change the MPHO type from kidney to liver.
First review done on September 15, 2018 (Kerstin)
@Mike: this paper predominantly describes the transmission into one kidney recipient. At the end, though, there is said very briefly that the liver recipient had a confirmed tumor transmission as well. Does that qualify the paper to be shown under "harm to a recipient" --- "liver", too? I think it should because it reports a transmission in the liver recipient, although without any details. But this is important to be found when searched by liver transplant professionals who do not necessarily search for transmission into kidneys?!
Expert comments for publication:
Fatal tumor transmission from an undetected donor malignancy at the time of organ procurement into 2 of 3 organ recipients. Immunosuppression might have facilitated the fatal and rapid course in the recipients. The authors note that to the best of their knowledge this is the first report of transmitted urothelial carcinoma. Also please recall that current recommendations for potential donors with small renal cell carcinomas do not extend to donors with urothelial carcinoma.