Case report: Synovial sarcoma transmission to three recipients (2021)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for sarcoma (Council of Europe, 2018): Donors with active sarcoma are considered to represent an unacceptable risk for organ donation regardless of disease stage. Donors with a history of sarcoma are also generally considered to represent unacceptable risks for transmission. After curative therapy and recurrence free survival of more than five years, they are still assumed to be associated with a high risk for transmission. Gastrointestinal stromal tumors are not grouped with other sarcomas and are considered separately.
Time to detection: 
Three recipients with transmitted tumor. Liver recipient had partial allograft resection at 3 months for suspected recurrent HCC but histopathology showed synovial sarcoma. The left kidney recipient was found to have a renal mass by ultrasound at 9 months and the right kidney recipient was found to have a tumor in the allograft at 13 months.
Alerting signals, symptoms, evidence of occurrence: 
None; initial detection was from screening of liver recipient for possible recurrent HCC. Screening of kidney recipients detected tumors a few months later.
Demonstration of imputability or root cause: 
DNA microsatellite analysis
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case report
Deceased donor
Kidney transplant
Liver transplant
DNA typing
Sarcoma, other or type not specified
Solitary fibrous tumor
Suggest references: 
Zhang J, Lin J, Tian Y. Transmission of Synovial Sarcoma by a Single Multiorgan Donor to Three Solid Organ Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). Accessed September 19, 2020.
Please also clone record for liver under MPHO type--> OK (EP) MN 5/7/21 KL concurs 5/5/22
Expert comments for publication: 
The donor was a 14 year old female with a lung tumor originally misdiagnosed as (benign) solitary fibrous tumor. The authors point out that such a diagnosis should be confirmed, given the possibility that it might represent a similar appearing malignant tumor such as synovial sarcoma. Limited recipient followup is given in this abstract. According to a chart, all 3 recipients were alive 19 months posttranspalnt. One kidney recipient underwent allograft nephrectomy, developed pulmonary metastases and was treated with Anlotinib with partial response. The other kidney recipient had a single lesion in the allograft that was treated with radiofrequency ablation and has not had further tumor. The liver recipient underwent partial hepatectomy and had recurrence in the right lobe (it is not stated whether this represented HCC or synovial sarcoma) and was alive without metastasis.