Case report: Renal cell carcinoma transmitted by heart transplant (1996)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
(Council of Europe, 2018): To provide a valid assessment, complete tumour resection (R0) prior to transplantation is required for the acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. The contralateral kidney should always be examined for synchronous RCC. RCC < 1 cm (Stage T1a AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) can be considered minimal risk for transmission. RCC 1-4 cm (Stage T1a AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered low risk. RCC > 4-7 cm (Stage T1b AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered intermediate risk. RCC > 7 cm (Stage T2 AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered high risk. RCC with extension beyond the kidney (Stages T3 or T4 AJCC 8th ed.) is considered a contraindication to transplant. All RCC with nucleolar grade III/IV (Fuhrman grade III/IV) are considered high risk for transmission. Contralateral kidneys and other organs that are uninvolved by carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and Fuhrman or nucleolar grade I-II. Followup surveillance is recommended. In the case of a donor with a history of renal cell carcinoma, the transmission risk of treated RCC depends on the recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease.
Time to detection: 
12 months after heart transplant
Alerting signals, symptoms, evidence of occurrence: 
Fatigue, decreasing alertness, brachiofacial hemiparesis; scan revealed multiple intracerebral space-occupying lesions; biopsy of soft lump frontal head: renal cell carcinoma metastasis, corresponding to cutaneous osteolytic metastases. Abdominal CT scan negative for tumor in kidneys.
Demonstration of imputability or root cause: 
Donor renal cell carcinoma was detected after heart explantation. No additional details are provided.
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
Heart transplant
Heart recipient
Histopathological examination
Renal cell carcinoma
Therapy discussed
Suggest references: 
Meyding-Lamadé U, Krieger D, Schnabel P, Sartor K, Sack FU, Gass P, Hacke W. Cerebral metastases of an allogenic renal cell carcinoma in a heart recipient without renal cell carcinoma. J Neurol. 1996 May;243(5):425-7. doi: 10.1007/BF00869005. PMID: 8741086.
Uploaded MN 5/8/22 first review CLFF 5/24/22 (if you want me to make a few phone call to obtain data from 1992 I could try - but all the people involved have most likely retired by now). 2nd review MN 5/28/22
Expert comments for publication: 
This likely represents transmission of renal cell carcinoma by heart transplant, although the evidence provided remains circumstantial. Since we lack data about tumor size etc in the donor, we can not conclude properly about the risks associated to this tumor. Knowing the best practice of the OPO team in 1992 at a minimum abdominal ultrasound had been performed routineously and information of local data had been exchanged (personal communication one reviewer). This shows up that beyond imaging the kidney must be inspected proplerly at procurement and communication to other teams is mandatory during the procedure. A remaining risk is, that during heart implantation a point of no return has been passed although kidney procurement has not been finished.