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:
Kidney recipient 1: multiple subcutaneous nodules on chest, back, abdomen and legs and a 10 cm mass in the graft. Biopsy revealed poorly differentiated malignancy, originally thought to be a lymphoma. Kidney recipient 2: graft function deterioration, ultrasound revealed an upper pole mass. No evidence of extrarenal spread. Biopsy revealed poorly differentiated malignancy, originally thought to be a Wilm´s tumor. (on retrospective analysis shown to be glioblastoma in both cases).
Demonstration of imputability or root cause:
Both kidney recipients received their organ form the same donor. Condition known in the donor - Glioblastoma Multiforme (GBM) with craniotomy performed. Two kidneys transplanted (no other organs) and both recipients affected. Retrospectively, the three tumors were compared, all meeting histological and immunochemical criteria of GBM, strongly supporting that both recipients had metastases from the primary central nervous system (CNS) tumor in the donor.
Suggest new keywords:
Single Center Series
Central nervous system
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Reduction of immunosuppression
Expert comments for publication:
Of 34 donors with CNS tumors in this series, 8 had glioblastoma and 12 had astrocytoma, with a variety of CNS tumors in the other donors.