Case report: Colorectal adenocarcinoma

Status: 
Ready to upload
Record number: 
1962
MPHO Type: 
Estimated frequency: 
Colorectal Cancer (Council of Europe 2018): Acceptance of pT1-tumours – see AJCC, 8th Edition 2016 – has been discussed but seems to have a certain risk of lymph node and distant metastases in the donor. Therefore this should only be accepted for organ donation with the highest 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). pT1/pT2 colorectal carcinoma (infiltration of submucosa/muscularis propria) of 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 should be taken into account. Even donors with an initially diagnosed pN1 stage have been accepted under special circumstances (full treatment and recurrence-free follow-up of at least >5 years, depending on the stage, with presumed cure), which might be associated with a higher transmission risk. An individual risk–benefit analysis should always be made. Lungs and liver should only be transplanted with the highest caution, since these are the organs most likely to harbor colorectal metastases.
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
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
malignancy
Large bowel cancer, other or type not specified
FISH (fluorescence in situ hybridization)
Sex chromosomes
DNA typing
DBD/donation after brain death
Case Report
Liver transplant/Liver recipient/Liver transplantation
Kidney transplant
Colorectal adenocarcinoma
Suggest references: 
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.
Note: 
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.