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Adverse Occurrence type:
Most recent risk assessment for leukemia (Council of Europe, 2018): donors with active leukemia are considered to represent an unacceptable risk for tumor transmission. Data at this time do not allow for discrimination of individual types of leukemias. Donors with treated leukemia after a disease-free interval of 5 to 10 years are assumed to represent a high risk for tumor 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.