Status:
Ready to upload
Record number:
2278
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
According to the authors, NET are detected in 1.8%-2.3% of patients undergoing incidental appendectomy. The prognosis and metastatic potential of appendix NET depend on their size. Criteria for intestinal NET classification and metastatic potential (Ki67 proliferation index, number of mistoses, tumor size, invasion) are described in the paper.
Most recent risk assessment for transmission of 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:
Two cases of intestinal tumors were detected during living donor hepatectomy, confirmation of definite diagnosis (grade 1 neuroendocrine tumor / NET) after transplantation.
Alerting signals, symptoms, evidence of occurrence:
Incidental detection of grade 1 NET in two living liver donors (26yo male/small intestine, and 29yo male/appendix). Both showed unsuspicious biochemical and radiological preoperative routine donor examinations.
According to the authors, in both cases, unfortunately no frozen section has been performed because they appeared either benign (intestine) or due to the small size and peripheral location (appendix) the decision for transplantation seemed not to be affected. Both livers were transplanted before the NET diagnosis was confirmed, the recipients were without any sign of transmission at the time of publication (unfortunately no timeline is described). Also, the two donors have no suspicion for tumor recurrence after oncological resection of the tumors and close follow-up.
Demonstration of imputability or root cause:
Not assessable
Imputability grade:
Not Assessable
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case report
Living donor
Liver transplant/Liver recipient/Liver transplantation
Neuroendocrine tumor
Reference attachment:
Suggest references:
Akbulut S, Isik B, Cicek E, Samdanci E, Yilmaz S. Neuroendocrine tumor incidentally detected during living donor hepatectomy: A case report and review of literature. World J Hepatol. 2018 Oct 27;10(10):780-784. doi: 10.4254/wjh.v10.i10.780. PMID: 30386471; PMCID: PMC6206150.
Note:
Uploaded MN 6/19/23
First review KM 7/29/24
Second review MN 7/29/24
Expert comments for publication:
This paper once more indicates the absolute necessity for thorough intra-abdominal inspection and palpation including non-transplantable structures like intestine and genitals in living (but also deceased) donors during organ procurement followed by frozen section of incidentally detected tumors. Small tumors can hide from perioperative imaging and may be detected by this approach. The authors strongly recommend a frozen section and additionally a backtable ultrasonography of the liver graft and to proceed with transplantation only if no hepatic lesion is identified.
The authors emphasize that, in living donors, the palpation of gastrointestinal organs may cause postoperative adhesions which can be avoided by using powderless gloves and a very gentle examination.