Adverse Occurrence type:
Most recent risk assessment for astrocytoma and glioblastoma (Council of Europe, 2022): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extraneural 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 transformation into a more aggressive malignancy can be ruled out. Since astrocytomas tend to relapse with a histologically higher grade of malignancy, new histological examinations to regrade the tumour should be performed where relapse occurs. If the tumour 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 extraneural metastases of anaplastic astrocytomas and glioblastoma are rare, but such metastases have been observed, and seem to 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 (WHO grade IV) are considered intermediate to high risk for transmission, depending on 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:
Alerting signals, symptoms, evidence of occurrence:
Intraperitoneal and intrahepatic mass identified on routine ultrasound. Histopathological examination revealed a poorly differentiated, small-cell pleomorphic cancer, identified as a glioma metastasis by S100- and glial fibrillary acidic protein immunohistochemical staining.
Demonstration of imputability or root cause:
Donor known to have glioblastoma multiforme (GBM). Surgical resection was performed 4 months prior to death, which occurred due to a relapse in the brain stem. Confirmation of transmission based on histopathology and immunohistochemistry.
Suggest new keywords:
Single Center Series
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Reduction of immunosuppression
Expert comments for publication:
Case series is of 13 donors with CNS neoplasms (4 GBM, 3 meningioma, 2 astrocytoma, 2 angioma, 1 neurocytoma, 1 ependymoma). This case represents the only transmission in this series. Both kidneys and heart from the same donor also transplanted with no evidence of transmission.