Status:
Ready to upload
Record number:
2164
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
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.
Time to detection:
4 months: indeterminate liver masses found; followup MRI and PET scan with biopsy confirmed malignancy at 6 months.
Alerting signals, symptoms, evidence of occurrence:
Two liver masses in routine ultrasound at 4 months; no signs or symptoms
Demonstration of imputability or root cause:
DNA microsatellite genotyping confirmd donor origin
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case Report
DBD/donation after brain death
Deceased donor
Liver transplant
Liver recipient
Liver transplantation
DNA typing
Lung cancer, small cell
Lung cancer, other
Therapy discussed
Reference attachment:
Suggest references:
Sonbol MB, Halling KC, Douglas DD, Ross HJ. A Case of Donor-Transmitted Non-Small Cell Lung Cancer After Liver Transplantation: An Unwelcome Guest. Oncologist. 2019 Jun;24(6):e391-e393. doi: 10.1634/theoncologist.2018-0517. Epub 2019 Feb 12. PMID: 30755501; PMCID: PMC6656516.
Note:
Uploaded MN 5/8/22
First review MN 4/12/23
Second review KM 4/13/23
Expert comments for publication:
The donor was a 50 year old male with a history of smokng and no evidence of lung cancer despite chest X-ray and bronchoscopy (performed to rule out infection), and no evidence of cancer on inspection at time of organ procurement. The tumor was diagnosed as mixed small cell and non-small cell type in the recipient. Although the tumor was confined to the allograft liver in the recipient, a decision was made to not retransplant since this was considered a metastatic cancer. The patient expired despite reduced immunpsuppression and chemotherapy. The decision not to retransplant might be debated, although a component of small cell carcinoma suggests an ominous prognosis regradless of approach. This case report highlights the fact that rare episodes of tumor transmission continue to occur despite reasonable precautions and screening, and emphasizes the importance of followup when donor risk factors (in this case smoking) exist.