Case report: Prostate adenocarcinoma transmitted by heart transplant (1997)

Record number: 
198
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for prostate cancer (Council of Europe, 2022): If Gleason score is available, e.g., prostate diagnostics have been initiated a few days before organ procurement, then small intra-prostatic, low-grade (Gleason score ≤ 6) tumours are considered minimal-risk; intra-prostatic tumours with Gleason score 7 are considered low-to-intermediate risk; and intra-prostatic (pT2c) tumours with Gleason score > 7 are considered high-risk. Histological examination of the entire prostate with a valid grading of the tumour is time-consuming and the results might not always be available before an organ is transplanted. Donors with extra-prostatic tumour extension should be unequivocally excluded from the donation process as an unacceptable risk. Prostate cancer in the donor history: The acceptable time intervals for complete remission of prostate cancer are strongly correlated with stage and Gleason grade of the tumour. Donors with a history of curatively treated prostate cancer ≤ pT2 (tumour confined to prostate) and Gleason 3 + 3, as well as donors with very small prostate cancers and Gleason 3 + 3 under ‘active surveillance’, can be accepted for organ donation as minimal transmission risk at any time after diagnosis with the prerequisite of a frequently performed and non-suspicious follow-up. Prostate cancer < pT2 (confined to the prostate) and Gleason grade < 7 after curative treatment and cancer-free period > 5 years is considered minimal-risk. Higher stages/grades and/or shorter cancer-free periods require an individual risk assessment. A history of extra-¬prostatic tumour extension poses a high risk for transmission. In any case, current PSA values should be obtained to compare to former ones and to assess the actual situation.
Time to detection: 
10 months
Alerting signals, symptoms, evidence of occurrence: 
10 months after transplant, new onset flank and back pain, with increased PSA (previous normal). Diagnosed with multiple bone lesions, rib biopsy containing adenocarcinoma with osteoblastic bone response consistent with metastatic prostate cancer. Tumor related death 36 months after transplant despite reduction of immunosuppression and chemotherapy.
Demonstration of imputability or root cause: 
Heart Tx operation about to be completed when a prostatic adenocarcinoma was discovered in pelvic lymph nodes of the donor. A postmortem examination of the donor revealed a moderately to poorly differentiated adenocarcinoma of the prostate with extracapsular extension into the seminal vesicles and metastatic foci in pelvic lymph nodes and adrenal glands. Recipient with normal prostate at diagnosis. Molecular genetic analysis of recipient rib specimen, which contained both histologically normal and neoplastic cells, was shown to contain a combination of alleles from the donor and recipient at 4 loci.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Prostate adenocarcinoma
Prostate carcinoma
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Expert comments for publication: 
It is significant that the donor had extracapsular and metastatic foci of prostate adenocarcinoma at the time of donation.