Ready to upload
Adverse Occurrence type:
Most recent risk assessment for leukemia, lymphoma and plasmacytoma (Council of Europe, 2022): Leukaemia, lymphoma and plasmacytoma diagnosed during donor procurement: These cancers are classified as an unacceptable risk for organ donation. Leukaemia, lymphoma and plasmacytoma in the donor history: Active (acute or chronic) leukaemia, lymphoma and plasmacytoma are an unacceptable risk for organ donation. Treated acute leukaemia and lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission.
Time to detection:
No evidence of disease after 1 year.
Alerting signals, symptoms, evidence of occurrence:
Mother to son living donor kidney transplant. At time of transplant a perihilar node was seen in the donor and sampled; Final Pathology diagnosed small lymphocytic lymphoma. Five months after nephrectomy, the donor also developed infraorbital tumor and is stable after 1 years following anti-CD20 therapy. The recipient has had no symptoms or evidence of disease. Of note, induction immunosuppression included anti-CD20 antibody due to ABO incompatibility.
Demonstration of imputability or root cause:
Disease documented in living donor, no evidence of disease in recipient at last followup.
Suggest new keywords:
Donor cancer without transmission
Leukemia, lymphocytic, chronic
Lymphoma, B-cell, other or not further specified
Tatarano S, Enokida H, Yamada Y, Nishimura H, Nakagawa M. Living Kidney Donor With Small Lymphocytic Lymphoma at the Time of Donation: A Case Report. Transplant Proc. 2018;50(8):2581-2.
Carl-Ludwig: second review: Agree to Michael. The special induction therapy in AB0 incompatible living donation may have some impact we do not know yet. Secondly I would like draw attention to the issues of long-term survivors with successful treatment of lymphoma / leukemia - which are said to be recurrence free and/or cured but still at risk to develop secondary malignancy. We do not have enough data and should try to merge her experience.
Expert comments for publication:
Disease transmission is excluded at least at the time of the report, one year posttransplant. CLL/SLL is slow growing and the patient should receive continued followup. The fact that anti-CD20 antibody was given at induction may have also led to an incidental anti-tumor effect, so it is also possible that no disease will develop. Regardless of the good outcome in this case, donor leukemia or lymphoma in general is generally considered to represent an unacceptable risk for transplantation.