Case Report: Donor derived duodenal adenocarcinoma arising in bladder-drained pancreas allograft (2022)

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This is a donor-derived duoudenal adenocarcinoma that arose 24 years after pancreas/kidney transplant with duodenal to bladder drainage. As such, it is not considered a "donor trnsmitted" tumor. No specific recommendations exist for donor duodenal adenocarcinoma as of early 2023.
Time to detection: 
24 years after combined kidney-pancreas transplant with bladder drainage. 24 years after Kidney (KI) +Pancreas (PA) Transpalntation TX with bladder drainage anstomosed of donor duodenum to recipient's urinary bladder. (PA failed after 2 yrs. with patial function, KI failed after 21 yrs. with retransplant after 23 yrs), after 24 yrs, PA-ectomy including duodenum (probably R0), reconstruciton of bladder, decrease of immunusppresion, one cyle of capecditabine/oxaliplatin (then discontinued due to side effects), after 11months (25 yrs): cystoscopy + imaging without signs of malignancy.:
Alerting signals, symptoms, evidence of occurrence: 
Microhematuria led to bladder biopsy showing a 5 mm tubular adenoma with focal high grade dysplasia. Concern for unsampled cancer led to resection which disclosed ductal adenocarcinoma arising in the donor duodenal segment.
Demonstration of imputability or root cause: 
Adenocarcinoma was restricted to the donor duodenal segment and was consistent with a primary tumor.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
donor derived
Small bowel adenocarcinoma
Case Report
Deceased donor
Pancreas transplant
Pancreas recipient
Histological features
Therapy discussed
Suggest references: 
Isaacson D, Steggerda J, Xue Y, Wren J, Javeed Ansari M, Auffenberg GB, Katariya N. Donor-derived duodenal adenocarcinoma of a bladder-drained pancreas allograft. Am J Transplant. 2022 Mar 24. doi: 10.1111/ajt.17042. Epub ahead of print. PMID: 35325501. see also: Amara D, Wisel SA, Braun HJ, et al. Metastatic donor-derived malignancies following simultaneous pancreas-kidney transplant: three case reports and management strategies. Transplant Direct. 2021;7(1):e636. // Roza AM, Johnson C, Juckett M, Eckels D, Adams M. Adenocarcinoma arising in a transplanted pancreas. Transplant. 2001;72(6):1156-1157.
Uploaded 5/3/22 MN CLFF frist reviewe 16/May/22 IT: WE cannot classify cancer of the upper gastrointestianl tract (duodenum/small bowel) Second review MN 1/23/23 Please add Gastrointestinal cancer -> Small bowel adenocarcinoma to the list of choices in the Malignancy section and select it for this record.--> OK done (EP)
Expert comments for publication: 
This is a donor derived tumor that arose 24 years after transplant, a time period that is more typically associated with urothelial carcinomas arising near the site of duodenal-bladder anastomoses. The presence of dysplasia in this small adenoma prompted resection, which uncovered invasive adenocarcinoma. Resection margins were free of tumor; the patient received an abbreviated course of chemotherapy due to intolerance. He remained free of tumor at the time of the report, approximately 2 years after tumor diagnosis. The authors note that this form of drainage, which peaked in the early 1990s, may be complicated by tumor formation. Although routine screening is not cost-effective, they suggest continuing attention to these patients.