Single center series: Glioblastoma multiforme

Record number: 
81
MPHO Type: 
Estimated frequency: 
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: 
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.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Neoplasia
Single Center Series
Case Report
Deceased donor
Liver transplant
Histologic analysis
Immunohistochemistry
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Glioblastoma multiforme
Reduction of immunosuppression
Patient death
Suggest references: 
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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.