Status:
Ready to upload
Record number:
2181
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for neuroendocrine tumors (including high grade neuroendocrine carcinomas, low(er) grade neuroendocrine tumors, carcinoid tumors, pheochromocytomas and paragangliomas) (Council of Europe, 2022):
Due to their potential for undetected metastasis, high-grade neuro-endocrine carcinomas are an unacceptable risk for organ donation. Insufficient information exists to guide practice for neuro-endocrine tumours, carcinoid tumours, phaeochromocytomas and paragangliomas. In the case of critically ill recipients, these tumours might be acceptable after a careful individual risk–benefit analysis.
Neuro-endocrine tumours in the donor history: No data are available from the literature. Due to this and their potential for undetected metastasis, treated high-grade neuro-endocrine neoplasms in the donor history are classified as high risk for organ donation. In the case of a previous history (> 5 years) of neuro-endocrine tumours (carcinoid tumours, phaeochromocytomas and paragangliomas) without any kind of disease recurrence or progression, donors should be considered high risk in the absence of sufficient information to guide practice.
Time to detection:
The original 2013 report notes that the patient had signs and symptoms suspicious for excess catecholamines "several months" after transplant. However, a followup report in 2015 to "clarify the timeline" of the case events states that the patient presented 6 years posttransplant with abdominal pain, nausea, vomiting and diarrhea.
Alerting signals, symptoms, evidence of occurrence:
Hypertension, tachycardia, sweating and palpitations were suspicious for excess catecholamines possible at 3 months; abdominal pain, nausea, vomiting and diarrhea at 6 years, at which times steps were taken to establish a diagnosis. (At that time CT showed 3 intrahepatic lesions up to 4.2 cm in largest diameter).
Demonstration of imputability or root cause:
FISH for sex chromosomes showed male genotype of the tumor in this male to female transplant.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Liver transplant
Liver recipient
Liver transplantation
FISH (fluorescence in situ hybridization)
Sex chromosomes
XY chromosomes
Immunohistochemistry
Paraganglioma
Pheochromocytoma
Therapy discussed
Reference attachment:
Suggest references:
Yang SE, Kim C, Wang H, Tatishchev S, Wray C, Nourmand H, Zarrinpar A, Tischler AS. RE: Anesthetic Management for Resection of Hepatic Paraganglioma Metastatic From the Donor Organ in an Orthotopic Liver Transplant Recipient: A Case Report. Transplant Proc. 2015 Jul-Aug;47(6):2072-3. doi: 10.1016/j.transproceed.2015.07.012. PMID: 26293099.
Sharma S, Wray C, Nourmand H. Anesthetic management for resection of hepatic paraganglioma metastatic from the donor organ in an orthotopic liver transplant recipient: a case report. Transplant Proc. 2013 Mar;45(2):817-9. doi: 10.1016/j.transproceed.2012.10.043. PMID: 23498826.
Note:
Uploaded MN 5/8/22
First review MN 11/21/23
** Please add "Parganglioma/pheochromocytoma" to Adverse occurrence type-> Harm to recipient -> Malignancy-> Neuroendocrine tumors and check off the box. -- OK done (EP)
Second review MCS 08/14/24
Expert comments for publication:
This case report is best read as a combination of the two references, with the 2013 paper focusing mainly on the anesthesiologic aspects and the 2015 report filling in clinicopathologic details. It represents the first report of donor origin paraganglioma transmission (originally 3 tumor nodules, radiofrequency ablation performed and later resection of residual 11.7 cm tumor mass). Symptoms might have been present early, but definitive presentation and evaluation occurred at 6 years posttransplant. The donor had evidence of a necrotic paraganglioma at the aortic bifurcation. The tumor in the recipient showed expression of SDHB (succinic dehrogenase subunit B) indicative of a mutation and a higher risk of malignant behavior. The authors also discuss one of the histologic grading systems for paraganglioma, which in this case would have also apparently suggested a significant risk of metastatic behavior. They highlight the importance of such information, since paragangliomas are most often considered to represent benign tumors with some malignant potential. Note that the authors refer to the tumor as a "metastatic" tumor; however, they use this term to indicate that the tumor originated from the donor. The tumor itself was localized to the allograft liver and did not metastasize beyond this organ. The final followup given showed the patient without disease ors symptoms 12 years after transplant.
The patient required surgical resection of an 11.7 cm intrahepatic lesion following several prior radiofrequency ablation procedures. Despite the size, no metastatic disease was found and the patient was well without disease at approximately 12 years posttransplant.