Case Report: Transmission of gastric cancer to four organ recipients (heart recipient) (2020)

Ready to upload
Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Origin of this cancer may be attributed to gastric or pancreatic or gastrotintestinal origin: Most recent risk assessment (Council of Europe, 2022): Oesophageal, gastric, pancreatic, liver and biliary cancers diagnosed during donor procurement : These tumours are classified as unacceptable risk. Oesophageal, gastric, pancreatic, liver and biliary cancers in the donor history: Treated tumours of these kinds in the donor history are classified as high risk due to their aggressive behaviour. Risk may decrease for early stages after curative therapy, with recurrence-free time > 5 years and with increasing probability of cure, especially in cases of long-term survivors
Time to detection: 
Heart: Posttransplant day (PTD) 131: cancer diagnosis, died of cancer PDT 143 Liver: PTD 140 symptomatic for cholestatis & pericholangitis, PTD 184 retransplantation, cancer found in removed graft, PTD 242 mutliple hypermetabolic foci, PTD 247 pericard effusion with cells of adenocarcinoma, no chemotherapy due to deteriorating status, died PTD 293 Kidney left: PTD 143 after symptoms CT multifocal metastatic disease, Chemotherapy PTD 186 (Capecitabine) after immunosuppression stopped; PTD 256 spinal metastasis - radiation, PTD 668 rash and adenaCa again diagnossed, PDT 725 graft removed, no tumor rejection, PTD 751 Pemborlizumab; PDT 812 dead, no autopsy Kidney right + Pancreas: PTD 151 graft pancreatitis, PTD 190 PET/CT diffuse nodal and ossoeus hypermetabolism, (As KI Left CA 19-9 elevated), PTD 195 graft ectomo (KI, PA: adenoCA). Immunosuppression withdrawn, Chemotherapy deferred, PTD 732 no evidence on recurrent cancer, on PTD 749 retransplant Kidney, PTD749+365: no signs of malignancy
Alerting signals, symptoms, evidence of occurrence: 
Heart: nothing reported in study Liver: elevation of enzymes -> symptomatic for cholestatis & pericholangitis -> retransplantation while imaging was without abnormalities Left kidney: anorexia, emesis, abdominal pain, distention, diarrhea - CT multifocal metastatic disease Kidney right + Pancreas: graft pancreatitis, elevation of CA 19-9
Demonstration of imputability or root cause: 
1. Same poorly differenciated adenocarcinoma of gastrointestinal origin (with CDH1 mutation and MET amplification) in all recipients 2. Short tandem repeat testing upon diagnosis of Cancer revealed donor derived tumor
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
Kidney transplant
Kidney recipient
Heart transplant
Heart recipient
Liver transplant
Liver recipient
Pancreas transplant
Pancreas recipient
Molecular typing
Sequence based analysis
Gastric adenocarcinoma
Small bowel adenocarcinoma
Pancreatic (ductal) adenocarcinoma
Suggest references: 
Atreya CE, Collisson EA, Park M, Grenert JP, Behr SC, Gonzalez A, Chou J, Maisel S, Friedlander TW, Freise CE, Shoji J, Semrad TJ, Van Ziffle J, Chin-Hong P. Molecular Insights in Transmission of Cancer From an Organ Donor to Four Transplant Recipients. J Natl Compr Canc Netw. 2020 Nov 2;18(11):1446-1452. doi: 10.6004/jnccn.2020.7622. PMID: 33152701.
Uploaded 5/4/22 MN Please (IT) clone this record with appropriate notation for each organ recipient type: Heart, Kidney, Kidney-Pancreas, Liver First review CLFF 5/16/2022 Second review MCS 23/05/22
Expert comments for publication: 
1. Same poorly differenciated adenocarcinoma of gastrointestinal origin (with CDH1 mutation and MET amplification) in all recipients: although Imunosuppression was stopped in both kidney (+PA) recipients with graft ectomy, only in one case tumor was "rejected" and did not recurr after chemotherapy. Also retransplantation of the liver did not result into survival without tumor recurrence in the liver recipient. This may indicate, that optimism should be limited to the interventions possible to cure recipients from donor derived cancer. 2. Short tandem repeat testing (or alternative methods) should be used upon diagnosis of cancer unexpectedly in a recipient in order to exclude donor derrived tumor from recipient's origin. This has major implications on the further therapy (as shown in the kidney+pancreas recipient in this case)