Status:
Ready to upload
Record number:
2158
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for colorectal cancer (Council of Europe, 2022):
Acceptance of pT1-tumours – see AJCC, 8th edition– Donors with pT1 tumours should only be accepted for organ donation with the utmost caution, and a high transmission risk must be assumed. Patients with higher stages of newly diagnosed, active colorectal cancer should not be accepted for organ donation (unacceptable risk).
Colorectal cancer in donor history: The presence of pT1/pT2 (Dukes’ A or B) colorectal carcinoma (infiltration of submucosa/muscularis propria) in the donor without lymph node or distant metastases is assumed to have a low transmission risk after adequate treatment and disease-free survival of > 5 years. Risk increases with stage, and probability of presumed cure has to be taken into account.
Time to detection:
Two female renal recipients from a 55 year old male donor with no evidence of malignancy. First patient (52 year old female): 5 months posttransplant. Second patient (22 year old female): 5 months posttransplant.
Alerting signals, symptoms, evidence of occurrence:
Patient 1: Worsening renal function, imaging showed renal pelvic thickening biopsy showed adenocarcinoma of probable gastrointestinal origin.
Patient 2: Uremia; imaging showed reduced renal artery caliber, 85% obstructed. Biopsy showed adenocarcinoma of gastrointestinal origin.
Demonstration of imputability or root cause:
No donor: recipient studies performed. On the basis of the approach of the UNOS DTAC, an episode in which there is no evidence of donor disease but in which more than one recipient develops disease and there is no evidence for pretransplant disease in the recipients would be categorized as Probable transmission. In the present case, XY chromosome analysis on the biopsy specimens would be possible and would confirm (or refute) donor origin.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Kidney transplant
Kidney recipient
Kidney transplantation
Large bowel adenocarcinoma
Therapy discussed
Reference attachment:
Suggest references:
K.G.R. Yamaçake, I.M. Antonopoulos, A.C. Piovesan, H. Kanashiro, R.B. Kato, W.C. Nahas,and D.S.R. David. Donor Transmission Intestinal Carcinoma After KidneyTransplantation: Case Report. Transplantation Proceedings,47, 827e830 (2015)
Note:
Uploaded MN 5/7/22
First review MN 4/12/23
Second review KM 4/13/23: @Mike: you have checked the "colorectal adenocarcinoma" box ... is this correct? I might have overseen something but from my first impression of the paper, the definite origin has not been specified? We could just check the "gastrointestinal cancer" box? Same for the keywords ... is the large bowel origin proven?
CLFF 21/05/24: transmission of tumor is only specified as intestinal carcinoma via immunhistochemical staining. Since small bowel is not correct too I would keep it to colon.
Expert comments for publication:
This is one of scattered reports in this Library in which the donor had no evidence of malignancy, but probable (in some cases) or proven (in some cases) malignancy transmission occurred. These cases highlight the need for continued vigilance in considering the possiblity of transmitted donor disease in recipients who develop posttransplant complications, particularly if signs and symptoms are unusual or not easily explained otherwise.