Status:
Ready to upload
Record number:
2193
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment (Council of Europe, 2022):
LUNG CANCER: Any histotype of newly diagnosed lung cancer is an unacceptable risk for organ donation.
Treated lung cancer in the donor history is considered to be associated with a high transmission risk. Risk may decrease after curative therapy, with recurrence-free time and with increasing probability of cure.
LYMPHOMA diagnosed during donor procurement is classified as an unacceptable risk for organ donation.
Lymphoma in the donor history is an unacceptable risk for organ donation. Treated lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission.
Time to detection:
LUNG CANCER: 2 years
LYMPHOMA: 18 months
Alerting signals, symptoms, evidence of occurrence:
No information about alerting signals or symptoms. No information about treatment after diagnosis of transmission.
LUNG CANCER kidney recipient died 3,5 years after transplant. Contralateral kidney and liver were transplanted without suspicion for transmission (kidney removed one year post-transplant due to graft failure, liver recipient lost to follow-up 8 years after transplant).
LYMPHOMA liver recipient died 6 months after transmission was confirmed. One kidney recipient from the same donor died 2 years after transplant due to unrelated causes, other kidney was not transplanted.
Demonstration of imputability or root cause:
Both tumors: DNA microsatellite array and karyotyping (female donor, male recipient) confirm donor transmitted malignancy.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Single Center Series
Deceased donor
Living donor
Kidney transplant
Kidney recipient
Liver transplant
Liver recipient
Sex chromosomes
Micro satellite analysis
Lymphoma, type not specified
Lung cancer, neuroendocrine and large cell cancer
Therapy not discussed
Donor derived
karyotype analysis
Reference attachment:
Suggest references:
Pandanaboyana S, Longbotham D, Hostert L, Attia M, Baker R, Menon K, Ahmad N. Transplantation of liver and kidney from donors with malignancy at the time of donation: an experience from a single centre. Transpl Int. 2016 Jan;29(1):73-80. doi: 10.1111/tri.12693. Epub 2015 Oct 26. PMID: 26402442.
Note:
upload MN 5/8/22
first review CLFF 5/24/22
Second review KM 7/1/24: @Notify-Team please clone this case also for "Risk of harm/Donor disease without transmission" because it shows multiple cases of known donor malignancies that did not result in transmission. -- OK done (EP)
Expert comments for publication:
This single center series show that a careful risk-benefit assessment of known donor-tumors can be a successful strategy to increase the organ donor-pool in times of organ shortage. Still, it has to be kept in mind that these tumors might have a certain potential for transmission and the recipient´s informed consent has to be be obtained.
This analysis covers 2546 kidney (KI) and liver (LI) transplants (2003-2014, deceased and living donation), recorded in a prospectively maintained database.
71 recipients (53 KI, 18 LI) received organs from 61 donors with malignancies.
TWO TRANSMISSIONS have been reported from donor tumors that were both unknown at the time of transplantation: one transmission of an occult donor LUNG CANCER in a kidney recipient and one LYMPHOMA transmission in a liver recipient (donor lymphoma was an unsuspected finding in a lymph node biopsy at procurement and was known only post-transplant).
NO TRANSMISSION has been reported after a median follow-up of 3.6 years from 48 active tumors (43 CNS (18 high-grade), 5 renal cancers) and 7 historical tumors (two breast DCIS, two cervical CIN III, one early thyroid papillary cancer, all treated >10 years prior to donation, one atrial myxoma, one liposarcoma) that had all been known before transplant.
Also no transmission has been observed in four recipients where the malignant diagnosis was only known after transplant: one liver recipient of a donor with a history of melanoma which had been excised several years before donation, one kidney recipient with the donor renal cell cancer found in a biopsy of a kidney scar taken at procurement. (here subsequent transplant nephrectomy was requested by the recipient).and two kidney recipients from a donor with lymphoma.
Additionally, the liver recipient of an occult donor gallbladder cancer had a retransplant due to primary nonfunction after 2 days and died the same due to unrelated causes.