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Adverse Occurrence type:
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2022): No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended, and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. Urothelial cancer in the donor history: Strict follow-up must have been provided after primary diagnosis because these tumours may be multicentric and tend to recur, with a need for repeated cystoscopy and TUR-B, and for restaging. Kidney transplantation will be associated with increased risk, but this has not been classified in the literature yet. After a disease-free interval > 5 years, the transmission risk of invasive urothelial cancer will depend on the probability of cure and must be assessed individually before accepting a potential organ donor. No specific recommendations are available from the literature.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Patient presented with gross hematuria and was found to have elevated creatinine and hydronephrosis
Demonstration of imputability or root cause:
Donor origin was excluded and recipient origin confirmed by XY chromosome FISH (fluorescence in situ hybridization)
Suggest new keywords:
FISH (fluorescence in situ hybridization)
Urothelial (transitional) cell carcinoma
Master VA, Meng MV, Koppie TM, Carroll PR, Grossfeld GD. Origin of urothelial carcinoma after renal transplant determined by fluorescence in situ hybridization. The Journal of Urology. 2002;167(6):2521-2.
I think this report should be in the library because it contains relevant information, but let me know if you disagree. MN review 4/16/22 KL concurs.
Expert comments for publication:
This 45 year old female transplant recipient of a kidney from a 29 year old male developed a urothelial carcinoma at the junction of the donor ureter and recipient bladder. Sex chromosome FISH showed the tumor cells to contain only XX, confirming recipient origin. It is noteworthy that this study, if relevant and available, can be performed on routine formalin fixed paraffin embedded biopsy tissue. The authors discuss the implications of this . Briefly, if of donor origin, graft nephrectomy with radical cystectomy would be considered, and notification of any potential recipient of the other kidney would be necessary. If of recipient origin, preservation of the donor kidney after cystectomy and urinary diversion could be considered, although the effect of continued immunosuppression would need to be considered. Removal of the native kidneys and ureters would also be reasonable due to continued risk for tumor.