Status:
Ready to upload
Record number:
2161
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
1. Most recent risk assessment for lung cancer (Council of Europe, 2022): Any histotype of newly diagnosed lung cancer is an unacceptable risk for organ donation.
Lung cancer in the donor history: Treated lung cancer is considered to be associated with a high transmission risk. Risk may decrease after curative therapy, with recurrence-free time and with increasing probability of cure.
2. 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:
14 months in kidney recipient #1; 13 months in kidney recipient #2
Alerting signals, symptoms, evidence of occurrence:
Acute onset of renal failure in both recipients together with other symptoms (fever, shortness of breath, diarrhea) led to CT scans showing multiple tumor masses in liver and allograft kidneys of both patients.
Demonstration of imputability or root cause:
DNA short tandem repeat studies showed donor origin in both patients.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
Kidney transplant
DNA typing
Immunohistochemistry
Lung cancer, neuroendocrine and large cell cancer
Therapy discussed
Reference attachment:
Suggest references:
Takeda K, Mittenzwei R, Geisinger KR, Datto MB, Rebellato LM. Donor-Derived Neuroendocrine Carcinoma Transmission to Two Kidney Transplant Recipients Demonstrated by Short Tandem Repeat Analysis: A Case Report. Transplant Proc. 2021 May;53(4):1337-1341. doi: 10.1016/j.transproceed.2021.03.002. Epub 2021 Apr 3. PMID: 33824012.
Note:
Uploaded MN 5/7/22
First review MN 9/3/23
Second review KM 7/1/24 Remarks @Mike:
1. Would it make sense to add a category "neuroendocrine tumors" under "Adverse occurrence type/Lung and lower respiratory system"? Or to rather list this paper under "lung cancer, other"? Or to label this tumor as "neuroendocrine tumor" instead of "lung tumor"? Just thinking from the users point of view who might not find it being under "small-cell lung cancer"?
2. Should we add "short tandem repeat" and "STR" to our keyword list and add this keyword here?
Adverse occurrence taxonomy not clear to me, please advise (EP)
MN Comment 8/28/24: Good point- I would suggest we could be inclusive by saying "Small cell and other neuroendocrine tumors" to be inclusive. It is a bit long, but there are all sorts of subtypes; large cell, intermediate cell, mixed, large cell with small cell immunophenotype, etc (not to mention carcinoid, tumorlets, etc.) so it might be the best approach. The main thing is to separate the lung neuroendocrine tumors, which are a major clinical category, from other neuroendocrine tumors throughout the body, which we are doing. Thanks MN
NEW AO TAXONOMY: Harm to a recipient/Malignancy/Lung and lower respiratory system/Lung cancer, small cell and other neuroendocrine tumors (EP)
Expert comments for publication:
The donor was a 62 year old male with a "history of heavy smoking" not further specified. There was no history of tumor and no signs of tumor at time of death. A chest X-ray and abdominal ultrasound were negative for tumor. The authors note that neuroendocrine tumors of lung typically arise centrally and early lesions could be missed by X-ray. This raises the question of whether CT/MRI scan should be considered in cases of donors with high risk features (such as heavy smoking).
One recipient was moribund and died shortly after the diagnosis and after receiving palliative care. The second recipient underwent transplant nephrectomy following by discontination of immunosuppression and chemotherapy with cisplatin/iriniotecan and was alive with significant shrinkage of hepatic masses at 3 year followup (both reipients were transplanted at the same center).
Images appear to show that the tumor is a neuroendocrine carcinoma but not a small cell carcinoma.