Status:
Ready to upload
Record number:
1859
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2022):
No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended, and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. Urothelial cancer in the donor history: Strict follow-up must have been provided after primary diagnosis because these tumours may be multicentric and tend to recur, with a need for repeated cystoscopy and TUR-B, and for restaging. Kidney transplantation will be associated with increased risk, but this has not been classified in the literature yet. After a disease-free interval > 5 years, the transmission risk of invasive urothelial cancer will depend on the probability of cure and must be assessed individually before accepting a potential organ donor. No specific recommendations are available from the literature.
Time to detection:
16 years after kidney (living donor, father) with approximately 15 years of function and 2 years after return to dialysis due to chronic rejection and non-function (kidney in situ, immunosuppression contnued) -> urothelial carcinoma originating from renal graft pelvis with dissemination into the native bladder of the recipient
Alerting signals, symptoms, evidence of occurrence:
Asymptomatic gross heamturia -> cystoscopy showed multipe tumors -> transurethral resection and CT scan -> histology: high-grade invasive urothelial carcinoma with squamous differentiation pT1 / CT scan showed additionally a thick wall at pelvi-ureteric junction of graft kidney -> -> cystectomy (no residual carcinoma found after previously performed TURBT: pT1, N0, M0), nephroureterectomy of graft (pT3, N0, M0) -> DNA-Analysis showed an XY karyotype of both, the kidney and bladder tumor, and thereby confirmed donor origin (male donor, female recipient). It is concluded that tumor cells grew initially in the graft kidney and implanted in the recipient bladder by urinary flow. Cessation of immunosuppression, no additional chemotherapy -> no recurrence of the multifocal urothelial carcinoma after follow up of 12 months.
Demonstration of imputability or root cause:
FISH: recipient female, donor male: XY in both tumors (kidney pelvis and bladder).
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Case Report
Living donor
Kidney transplant
FISH (fluorescence in situ hybridization)
Urothelial (transitional) cell carcinoma
Malignancy
Reference attachment:
Suggest references:
Takaoka E-i, Miyazaki J, Kimura T, Kojima T, Kawai K, Murata Y, et al. Concurrent urothelial carcinoma in the renal pelvis of an allograft kidney and native recipient bladder: evidence of donor origin. Japanese journal of clinical oncology. 2014;44(4):366-9.
Note:
second review done June 17, 2018 (Kerstin)
Expert comments for publication:
The authors discuss the ability of the recipient´s organism to reject possible residual tumor cells after resection of the kidney graft and subsequent restoration of the recipient´s immunity by cessation of immunosuppression. This is a great advantage in kidney transplantation due to the possibility of dialysis (not possible for other organs where retransplantation would be needed to survive). Additionally, the authors discuss the etiology of the frequent multifocal nature of urothelial carcinoma and describe that the urinary flow is an important component in heterotopic recurrence (tumors of the renal pelvis and ureter have a 30-40% risk of developing bladder carcinoma while bladder tumors rarely spread to the upper urinary tract (2-6%). They additionally discuss the results of recent molecular genetic studies which showed evidence for a common clonal origin in most multifocal urothelial cancers.