Adverse Occurrence type:
Most recent risk assessment for lymphoma (Council of Europe, 2018): donors with active lymphoma are considered to represent an unacceptable risk for tumor transmission. Insufficient data exist at present to discriminate among different lymphoma subtypes. Donors with a history of treated lymphoma after a disease-free interval of 5 to 10 years are assumed to represent a high risk for transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
On brain biopsy, the donor was found to have anaplastic central nervous system T-cell lymphoma, and the recipient of the donor's pancreas, liver and kidneys were found to have involvement of T-cell lymphoma.
Demonstration of imputability or root cause:
Evaluated by OPTN/UNOS Disease Transmission Advisory Committee (DTAC) as confirmed transmission. (8 donors transmitted disease to 6 recipients, includes separately reported case of Harbell et al in which 1 donor transmtited disease to 4 recipients The transplanted kidneys and pancreas were excised from the respective recipients, and the kidney and pancreas recipients responded well to chemotherapy. The liver recipient underwent three cycles of chemotherapy, but later died due to complications of severe tumor burden.)
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Expert comments for publication:
Donor was thought to have bacterial meningitis, highlighting the difficulties in assessing CNS patients and underscoring the need to have reasonable diagnostic confirmation.