Status:
Ready to upload
Record number:
1580
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2022):
No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended, and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. Urothelial cancer in the donor history: Strict follow-up must have been provided after primary diagnosis because these tumours may be multicentric and tend to recur, with a need for repeated cystoscopy and TUR-B, and for restaging. Kidney transplantation will be associated with increased risk, but this has not been classified in the literature yet. After a disease-free interval > 5 years, the transmission risk of invasive urothelial cancer will depend on the probability of cure and must be assessed individually before accepting a potential organ donor. No specific recommendations are available from the literature.
Time to detection:
14 months
Alerting signals, symptoms, evidence of occurrence:
Episodes of fever and liver enzyme abnormalities. Consecutive ultrasound and CT scan revealed a 5cm hypodense lesion in the transplanted liver.
Demonstration of imputability or root cause:
Open liver biopsy demonstrated a clear cell tumor of urothelial origin. The same tumor had been found in one of the kidney recipients of the same donor 5 months before.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
urothelial carcinoma
transitional cell carcinoma
clear cell
histological examination
malignancy
metastatic
transplantectomy
chemotherapy
Reference attachment:
Suggest references:
Backes AN et al. Transmission of clear cell tumor in a graft liver from cadaveric donor: case report. Pediatr Transplant. 2012 Dec;16(8):E352-5
Note:
Would suggest removing the keywords "abnormal blood counts, first generation, second generation" which are not relevant to this report (ok - Evi)
Expert comments for publication:
Very unusual example of urothelial carcinoma transmission to a non-renal recipient as well as one of two renal recipients. No detailed documentation beyond routine histology regarding assignment of urothelial origin to the tumor. However, one adult recipient of one of the kidneys developed transitional cell carcinoma in the graft at 9 months. Urothelial carcinoma would be an unlikely tumor to arise in this pediatric liver reipient, and if it was a primary tumor it could not reasonably be expected to be isolated to the allograft without evidence of a primary tumor in the renal collecting system. Therefore, these circumstances lead us to consider donor origin proven, rather than probable. The liver recipient was treated successfully. She underwent retransplantation and chemotherapy and is free of tumor at four year followup.