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:
3 months (but donor hilar lymph node biopsied at time of transplant was interpreted as metastatic glioblastoma on final pathology report)
Alerting signals, symptoms, evidence of occurrence:
Three months after bilateral lung transplantation, patient found to have diffuse bilateral pulmonary infiltrates and pleural effusions. Diagnosis of metastatic Glioblastoma Multiforme (GBM) was made through bronchoscopy and transbronchial biopsy.
Demonstration of imputability or root cause:
Donor diagnosed was diagnosed with Glioblastoma multiforme (GBM) 1 year before death by stereotactic brain biopsy, but known to have a 9- by 7-cm parietal mass for 3 years. Donor was treated with steroids for 2 years and with radiotherapy. Lungs, heart, kidneys and liver were transplanted into five different recipients. One enlarged hiliar lymph node had been found while the lungs were being transplanted; the lymph node was removed and was consistent with metastatic GBM of the small cell type.GBM found in lung transplant recipient had identical histological features to those seen in the lymph node previously mentioned.More than one recipient from the same donor was affected: bilateral lung and liver recipients. One kidney recipient had transplantectomy, tumor not mentioned. Other kidney and heart recipients had no evidence of transmission.
Suggest new keywords:
FISH (fluorescence in situ hybridization)
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)