Status:
Ready to upload
Record number:
2172
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:
11 days post-transplant
Alerting signals, symptoms, evidence of occurrence:
Abdominal ultrasound detected a clinically silent 1.5 cm hypoechogenic lesion in the allograft liver on post-tranplant day 11. This was stable on followup for 11 months (originally thought to be a hemangioma), when two additional liver lesions were seen on MRI. All were stable for 2.5 additional years and at that point MRI showed lesion growth and additional lesions.
Demonstration of imputability or root cause:
DNA fingerprinting was performed and matched the donor genotype; additionally, there was a sex mismatch consistent with donor origin.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Deceased donor
Liver transplant
Liver recipient
Liver transplantation
DNA typing
DNA fingerprinting
Histologic analysis
Immunohistochemistry
Neuroendocrine tumor
Therapy discussed
Reference attachment:
Suggest references:
Mrzljak A, Kocman B, Skrtic A, Furac I, Popic J, Franusic L, Zunec R, Mayer D, Mikulic D. Liver re-transplantation for donor-derived neuroendocrine tumor: A case report. World J Clin Cases. 2019 Sep 26;7(18):2794-2801. doi: 10.12998/wjcc.v7.i18.2794. PMID: 31616694; PMCID: PMC6789388.
Note:
Uploaded MN 5/8/22
First review MN 11/12/23
Second review AE 23/06/24
Expert comments for publication:
This was a slow-growing well differentiated neuroendocrine tumor (not a high-grade neuroendocrine carcinoma) that was limited to the allograft liver. The patient underwent a second liver transplant 5 years after the original transplant and was without evidence of tumor on followup 12 months later. No other anti-tumor therapy had been given in the interim. On examination, the original allograft explant was approximately 60% replaced by tumor. The donor was a 73 year old woman with no known malignancy who died of intracerebral hemorrhage. The authors briefly discuss published cases of well and poorly differentated neuroendocrine tumors transmitted by transplantation and note that treatment is individualized, with retransplantation a possibility in some cases that are limited to the graft.