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Adverse Occurrence type:
Most recent risk assessment for Lung Cancer (Council of Europe, 2018): Any form of newly diagnosed lung cancer represents an Unacceptable Risk for organ donation. Treated lung cancer is considered to be High Risk, but this may be modified by curative therapy and recurrence-free time with increasing probability of cure.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
PET CT followup at 30 months showed positive node in left upper lobe (allograft); resection showed sqamous cell carcinoma. Two years later 2 nodules in left upper lung found; one was squamous cell carcinoma, the second was pulmonary adenocarcinoma. No pleural invasion.
Demonstration of imputability or root cause:
Appears of donor origin based on localization to allograft lung without involvement elsewhere, arising a relatively short time after transplant. No molecular or other studies done. Also noted that donor was a smoker, had normal CT scan prior to death.
Suggest new keywords:
Lung cancer, adenocarcinoma
Lung cancer, squamous cell (bronchogenic)
Rodrigues D, Borro JM, Amado J, Vaz AP. Metachronous Pulmonary Neoplasms in Lung Transplantation-When They Arise in the Donor Lung: A Case Report. Transplant Proc. 2018;50(10):4075-9.
Please clone also for harm to recipient, lung adenocarcinoma under the lung carcinoma heading - OK (EP) 2nd review by Carl-Ludwig: Agree to Michael.; unfortunately the study can not provide data to confirm or exclude the origin of donor or recipient derived finally, but due to anatomical localisation of the tumors this is possible. Of note, the recipient passed away due to rejection and not tumor spread (all three nodules have been pT1aNxR0).
Expert comments for publication:
Although the donor had a smoking history and the first tumor arose 30 months after transplant, the recipient also had heavy silica exposure and the possibility remains that the tumor arose from donor cells in the early posttransplant period, although this appears unlikely.