Case report: Malignant glioma transmitted by pancreas transplant (kidney recipient uninvolved) (2010)

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MPHO Type: 
Estimated frequency: 
(Council of Europe, 2018): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extra-neural metastases from low grade astrocytomas (WHO grade II) are rare, and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of more aggressive malignancy are ruled out. Since astrocytomas have a tendency to relapse with a histologically higher grade of malignancy, new histological examinations should be performed where relapse occurs to regrade the tumour. If the tumor co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high grade and will be associated with an increased risk of transmission. Spontaneous extra-neural metastases of anaplastic astrocytomas and glioblastoma multiforme are rare, but have been observed, and occur more frequently when associated with prior surgical treatment and/or ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma multiforme (WHO grade IV) are considered intermediate to high risk for transmission depending on the different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection: 
4 months
Alerting signals, symptoms, evidence of occurrence: 
A routine 4 month protocol imaging study showed a pancreatic mass by ultrasound. The patient had abdominal pain. CT scan confirmed a mass.
Demonstration of imputability or root cause: 
Biopsy with immunohistochemistry was consistent with a malignant glioma, characterized as WHO Grade III pleomorphic xanthoastrocytoma, which was identical to that of the donor.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
DBD/donation after brain death
Pancreas transplant
Pancreas recipient
Pancreas transplantation
Kidney transplant
Kidney recipient
Kidney transplantation
Histologic analysis
Astrocytoma (WHO grade 3)
Therapy discussed
Suggest references: 
Perosa M, Crescentini F, Antunes I, Marchini G, Rosemberg S, Bezerra A, Genzini T. Donor-derived malignancy in a pancreas graft. Transpl Int. 2010 May 1;23(5):e5-6. doi: 10.1111/j.1432-2277.2009.00989.x. Epub 2009 Nov 5. PMID: 19895378.
Uploaded MN 5/8/22 Please clone for kidney transplant t, and in that one change donor harm to risk of harm, unsuitable organ etc. First review MN 5/13/22 second review CLFF 5/15/22 agree to statement after independent read & same conclusions. I am afraid it is overlooked, that the risk of transmission maybe modified during longterm follow up of WHO Grade IV tumor due to time (chance for clonal modification plus add on exposer to different means of treatment) therefore I added a sentence.
Expert comments for publication: 
The donor was an 11 year old female who was diagnosed with malignant glioma at age 4. Craniotomy at that time showed Grade III pleomorphic xanthoastrocytoma that was resected. At age 10 she was symptomatic and had recurrence. Three additional craniotomies were performed for removal. After a fourth craniotomy she proceeded to brain death. No extra-CNS tumor was found at time of donation. Heart, liver, one kidney and pancreas were transplanted. The heart and liver recipients died a few days after transplant, the kidney recipient had no evidence of tumor transmission. The pancreas recipient underwent graft pancreatectomy; no tumor was found outside of the pancreas and the recipient was tumor free for 5 years at the time of the report. Based on this experience the transplant center no longer accepts organs from donors with CNS tumors if any risk factors (high grade malignancy, prior craniotomy, ventriculosystemic shunt, prior radiotherapy, long time interval between primary treatment and relapse) are present. Please refer to additional records to see larger scale statistics of CNS tumor risk, in addition to Council of Europe recommendations. Awareness about the modified risk of tumor transmission due to longlasting disease needs further to be evaluated.