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Adverse Occurrence type:
Most recent risk assessment for colorectal cancer (Council of Europe, 2022): Acceptance of pT1-tumours – see AJCC, 8th edition  – Donors with pT1 tumours should only be accepted for organ donation with the utmost caution, and a high transmission risk must be assumed. Patients with higher stages of newly diagnosed, active colorectal cancer should not be accepted for organ donation (unacceptable risk). Colorectal cancer in donor history: The presence of pT1/pT2 (Dukes’ A or B) colorectal carcinoma (infiltration of submucosa/muscularis propria) in the donor without lymph node or distant metastases is assumed to have a low transmission risk after adequate treatment and disease-free survival of > 5 years. Risk increases with stage, and probability of presumed cure has to be taken into account.
Time to detection:
18 months after liver transplant detected by contrast enhanced ultrasound sonography of liver graft. Biopsy revealed metastatic colon cancer. Due to other co-morbitities re-transplanation with removal of the graft has not been performed. The patient passed away after 18 months. Coloscopy at time of diagnosis showed no colon tumor in recipient, extrahepatic manifestation was not detected. Two kidney recipients of the same donor remained tumor free. Autopsy of donor not performed, at time of donation no clinical suspicion for cancer.
Alerting signals, symptoms, evidence of occurrence:
Imaging (recipient originally had HCC in explanted liver).
Demonstration of imputability or root cause:
FISH of X/Y as donor was female and recipient was male plus genotyping (short tandem repeats) confirmed donor origin
Suggest new keywords:
Large bowel cancer, other or type not specified
FISH (fluorescence in situ hybridization)
DBD/donation after brain death
Liver transplant/Liver recipient/Liver transplantation
Zelinkova Z, Geurts-Giele I, Verheij J, Metselaar H, Dinjens W, Dubbink HJ, et al. Donor-transmitted metastasis of colorectal carcinoma in a transplanted liver. Transplant international : official journal of the European Society for Organ Transplantation. 2012;25(1):e10-5.
Please clone this record and in the cloned record change the MPHO from liver to kidney, and also change "arm to a recipient" to "risk of harm, unsuitable MPHO", since neither of the kidney recipients developed tumor. Mike N 9/26
Expert comments for publication:
The authors note that no autopsy was performed; however, the point of examining the bowel thoroughly at time of organ recovery might also be emphasized.