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, 2025): Prostate cancer diagnosed during donor procurement: If Gleason score is available, e.g. prostate diagnostics have been initiated a few days before organ procurement, then small intraprostatic, low-grade (Gleason score ≤ 6) tumours are considered minimal-risk; intraprostatic tumours with Gleason score 7 are considered low-to-intermediate risk; and intraprostatic 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 extraprostatic 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 score 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 score = 7 after curative treatment and cancer-free period > 5 years is considered minimal- risk.

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:

Malignancy

Keywords:

adenocarcinoma

heart transplantation