Adverse Occurrence type:
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:
17 -18 months
Alerting signals, symptoms, evidence of occurrence:
Mass in both recipients of the kidneys from the same donor. One patient presented with fever and mass detected in graft. Second patient developed hypertension around the same time and was evaluated for mass following information from the physicians treating the first recipient.
Demonstration of imputability or root cause:
Condition known in the donor who had been treated with surgery and radiotherapy. Two recipients affected from the same donor. Kidney graft removal was performed in both recipients. Both were alive and disease-free 15 months after transplantectomy. Histology and immunocytochemistry confirmed diagnosis in both patients.
Suggest new keywords:
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)