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Adverse Occurrence type:
This Review covers only cases with events of Transmission of GBM to transplant recipients (11 studies, 11 cases: 3 liver recipients, 3 kidney recipients, 5 lung recipients). The paper includes cases already published in other reports. No controll Group provided with cases without Transmission events observed. Most recent risk assessment for astrocytoma and glioblastoma (Council of Europe, 2022): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extraneural metastases from low-grade astrocytomas (WHO grade II) are rare and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors, the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of transformation into a more aggressive malignancy can be ruled out. Since astrocytomas tend to relapse with a histologically higher grade of malignancy, new histological examinations to regrade the tumour should be performed where relapse occurs. If the tumour co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high-grade and will be associated with an increased risk of transmission. Spontaneous extraneural metastases of anaplastic astrocytomas and glioblastoma are rare, but such metastases have been observed, and seem to occur more frequently when associated with prior surgical treatment and/or ¬ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma (WHO grade IV) are considered intermediate to high risk for transmission, depending on different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ¬ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection:
This Review covers only cases with events of Transmission of GBM to transplant recipients (11 studies, 11 cases: 3 liver recipients, 3 kidney recipients, 5 lung recipients). The paper includes cases already published in other reports. No controll Group provided with cases without Transmission events observed. Time range from Transplantation to detection of glioma in 3 kidney recipients 17 to 18 months, 2 liver recipients 4 to 9 months, 3 lung recipients 3 to 15 months (other cases: no data). All 3 kidney recipients alive 32 to 33 months after transpaltantion, all 4 liver recipients died at 5 to 10 months after Transplantation, two lung recipients died at 3 and 16 months post Transplantation. Please note: in all cases the donor previous history of a GBM was known with a variable extend to exposure of risk factors for increased probability of tumour Transmission.
Alerting signals, symptoms, evidence of occurrence:
Alerting singals were: space occupying lesion (SOL) in graft (n=6 of 11), SOL or lymph node enlargement outside graft (n=8 of 11); in lung pleural effusion (n=4 of 5) or SOL of mediastinum (n=3 of 5); please note mutliple counts are possible. Evidence of occurence was confirmed by histopathologic examination of the SOL etc. with cells positive for S100 and/or GFAP and/or CD56 markers for GBM and/or histomorphology -> wide range of yes/no for the items.
Demonstration of imputability or root cause:
Histology (morphology or either one of the markers typical to confirm GBM was detected in SOL in recipients). Root cause: known risk associated to Transplantation for grafts procured from donors affected by GBM. Interestingly not all recipients of all donors developed GBM Transmission events. Risk of harm: selfspeaking.
Suggest new keywords:
Kidney transplant/Kidney recipient/Kidney transplantation
Liver transplant/Liver recipient/Liver transplantation
Lung transplant/Lung recipient/Lung transplantation
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Jimsheleishvili S, Alshareef AT, Papadimitriou K, Bregy A, Shah AH, Graham RM, et al. Extracranial glioblastoma in transplant recipients. J Cancer Res Clin Oncol. Springer Berlin Heidelberg; 2014 May;140(5):801–7.
Second review. KL 05/30/18