Status:
Ready to upload
Record number:
1914
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:
7 months
Alerting signals, symptoms, evidence of occurrence:
The patient received a double lung transplant for treatment of usual interstitial nephritis. Patient was well but developed bronchitis 6.5 months after transplant. CT done at 7 months to assess chronic rejection showed a 6 cm paracarinal lymph node and two small intrapulmonary nodules. Histology showed large cell carcinoma with partial sarcomatoid differentiation. Chemotherapy was given followed by right sided pneumonectomy. PET-CT 4 months later showed multiple bone metastases and new left lung lesion. The patient died 7 months after diagnosis.
Demonstration of imputability or root cause:
HLA haplotype analysis showed donor origin.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Case report
Deceased donor
Lung transplant
DNA typing
Lung cancer, adenocarcinoma
Lung cancer, other
chemotherapy
transplantectomy
Reduction of immunosuppression
Immunohistochemistry
Reference attachment:
Suggest references:
von Boehmer L, Draenert A, Jungraithmayr W, Inci I, Niklaus S, Boehler A, et al. Immunosuppression and lung cancer of donor origin after bilateral lung transplantation. Lung cancer (Amsterdam, Netherlands). 2012;76(1):118-22.
Note:
Reviewed 7/26/19; OK to upload MN
Expert comments for publication:
As part of the study the heavy lymphoid infiltrate associated with the tumor was analyzed. Despite frequent T cells, no expression of perforin or granzyme B was seen and regulatory FoxP3+ cells were identified. The authors noted that mouse models show that efficacy of radiotherapy and chemotherapy depend upon intact immune effector functions and suggest that this might have contributed to inability to control the cancer. They also note that mTOR inhibitors might have a role in reducing the frequency of this complication, although additional studies are necessary.
Neither the donor nor the recipient had a smoking history.