Status:
Ready to upload
Record number:
2154
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for neuroendocrine tumors (including high grade neuroendocrine carcinomas, low(er) grade neuroendocrine tumors, carcinoid tumors, pheochromocytomas and paragangliomas) (Council of Europe, 2022):
Due to their potential for undetected metastasis, high-grade neuro-endocrine carcinomas are an unacceptable risk for organ donation. Insufficient information exists to guide practice for neuro-endocrine tumours, carcinoid tumours, phaeochromocytomas and paragangliomas. In the case of critically ill recipients, these tumours might be acceptable after a careful individual risk–benefit analysis.
Neuro-endocrine tumours in the donor history: No data are available from the literature. Due to this and their potential for undetected metastasis, treated high-grade neuro-endocrine neoplasms in the donor history are classified as high risk for organ donation. In the case of a previous history (> 5 years) of neuro-endocrine tumours (carcinoid tumours, phaeochromocytomas and paragangliomas) without any kind of disease recurrence or progression, donors should be considered high risk in the absence of sufficient information to guide practice.
Time to detection:
N/A: No tumor transmission was seen at the time of report, with 2 year followup.
Alerting signals, symptoms, evidence of occurrence:
None. The patient was followed with catecholamine levels and radionuclide scan with no evidence of tumor transmission.
Demonstration of imputability or root cause:
N/A: No transmission of donor tumor was seen.
Imputability grade:
0 Excluded
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Kidney transplant
Pheochromocytoma
Adrenal cancer
Therapy not discussed
Reference attachment:
Suggest references:
Abdalla AH, Rassoul Z, Mousa DH, al Hussaini H, al-Hawas F, al-Sulaiman MH, al-Khader AA. A pheochromocytoma in a cadaver kidney donor: to transplant or not to transplant? Nephrol Dial Transplant. 1996 Oct;11(10):2080-2. doi: 10.1093/oxfordjournals.ndt.a027103. PMID: 8918729.
Note:
Uploaded MN 5/4/22
First review MN 9/3/23
Consider adding adrenal ->pheochromocytoma in the Malignancy category.
Expert comments for publication:
This case report describes an ipsilateral kidney transplant from a donor with an adrenal pheochromocytoma, 6x4x2 cm with capsular invasion, vascular invasion, and local extension into the liver (found on permanent sections but not on original frozen section diagnosis at time of transplant). No metastases were found in the donor.
Less than 10% of pheochromocytomas are considered malignant, with metastasis being the only definitive indicator of malignancy. Various pathologic scoring systems (including variables such as size, weight, necrosis, mitotic rate, infiltration) exist to assess likelihood of malignancy, but no single criterion is definitive.
In this report, the contralateral kidney was also transplanted but that recipient died shortly after transplant from unrelated causes. At the time of review (2023), we are unaware of any additional publications describing transplantation in the setting of donor pheochromocytoma.