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:
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.