Record number:
87
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
- Most recent risk assessment for astrocytoma WHO grades 3 or 4 and glioblastoma WHO grade 4 (Council of Europe, 2025):
Spontaneous extraneural metastases of grade 3 astrocytomas and grade 4 glioblastomas 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 WHO grade 3 astrocytomas can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors.
Potential donors with glioblastoma IDH-wildtype or astrocytoma IDH-mutant are considered intermediate risk for transmission, depending on different national recommendations, which are expected to be adjusted with increasing evidence.
The transmission risk is increased in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy.
Time to detection:
10 months
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.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Neoplasia
Single Center Series
Deceased donor
Kidney transplant
Histologic analysis
Immunohistochemistry
Central nervous system
Glioblastoma multiforme
Astrocytoma/glioblastoma multiform E. (WHO grade 4)
Transplantectomy
Reduction of immunosuppression
Irradiation
Patient survival
Suggest references:
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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.