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Adverse Occurrence type:
Most recent risk assessment for leukemia, lymphoma and plasmacytoma (Council of Europe, 2022): Leukaemia, lymphoma and plasmacytoma diagnosed during donor procurement: These cancers are classified as an unacceptable risk for organ donation. Leukaemia, lymphoma and plasmacytoma in the donor history: Active (acute or chronic) leukaemia, lymphoma and plasmacytoma are an unacceptable risk for organ donation. Treated acute leukaemia and lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission.
Time to detection:
2 years (kidney recipient); liver recipient with no evidence of disease at that time.
Alerting signals, symptoms, evidence of occurrence:
Patient presented ill with aphthous stomatitis, leg edema, found to be pancytopenic; bone marrow biopsy showed AML with 80% blasts.
Demonstration of imputability or root cause:
XY chromosome FISH analysis and short tandem DNA repeat analysis of donor and recipient cells.
Suggest new keywords:
Leukemia/acute myelogenous (includes myeloid sarcoma)
Girsberger S, Wehmeier C, Amico P, Dirnhofer S, Marti E, Halter JP, et al. Donor-derived acute myeloid leukemia in a kidney transplant recipient. Blood. 2013;122(2):298-300.
First review done 9/26 MN- please clone record and in cloned record, change "harm to recipient" to "Risk of harm- inappropriate MPHO released" and change MPHO from kidney to liver, since there was also a liver recipient who did not develop leukemia. Second Review done 9/26 CLFF, agree.
Expert comments for publication:
Unusual case in that the recipient of a double kidney transplant developed AML of donor origin 2 years after transplant, and the liver recipient was free of disease. The donor had no known disease and at donor autopsy spleen was normal. The authors suggest 3 possibilities: 1: donor hematopoietic precursors engrafted with the kidney and underwent leukemic transformation posttransplant; 2: a donor leukemic stem cell or clone was transplanted with the kidney, or 3: an abnormal hematopoietic cell differentiated from kidney tissue (although the kidney has no known potential for this). They favor possibility #1. This may be correct. However, donor leukemic transmission, although high in frequency, is not 100%, so #2 cannot be entirely excluded. But 2 years would be a bit long for an actively transplanted leukemia to become clinically manifest, so the first possibility remains likely.