Death from donor-transmitted malignancy despite emergency liver retransplantation

Abstract

Transplantation of organs procured from donors with malignancies identified subsequent to implantation presents a significant dilemma regarding the optimal management strategy to simultaneously minimize the risk for cancer transmission and recipient morbidity. In this report, we present a patient who underwent orthotopic liver transplantation for hepatitis B cirrhosis. The donor had no previous history of cancer. On autopsy, enlarged mediastinal lymph nodes led to the discovery of a 1-cm lung tumor. Histological examination showed pulmonary adenocarcinoma with metastatic mediastinal disease. Despite urgent retransplantation within 7 days, the recipient developed metastatic pulmonary adenocarcinoma diagnosed 11 months after transplantation and died soon thereafter. Analysis of short tandem repeat regions of chromosomal DNA from the recipient, the 2 liver donors, and the posttransplantation tumor corroborates that the first donor was the source of the malignancy. This case of donor-transmitted malignancy underscores the need for vigilance by the procuring surgeon in identifying potential malignancy during organ retrieval and use of a full autopsy on selected donors after organ procurement. (Liver Transpl 2003;9:1102-1107.)

Extended Survival by Urgent Liver Retransplantation after Using a First Graft with Metastasis from Initially Unrecognized Donor Sarcoma

“…Lipshutz et al (14) reported the case of a liver recipient who was urgently retransplanted after the donor was found to harbor a pulmonary adenocarcinoma with metastatic mediastinal disease. This patient nevertheless succumbed to this donor transmitted malignancy 11 months after the procedure.…”

Donor derived malignancy following transplantation: a review

“…Again, in a case of re-transplantation of a liver allograft recipient with localized adenocarcinoma from the donor, the recipient was doing well at the one year follow up (Donovan et al 1997). In contrast, despite emergency re-transplantation in a liver recipient from a donor found to have metastatic adenocarcinoma in the lung, the recipient died within 7 days due to metastatic adenocarcinoma (Lipshutz et al 2003).…”

“…Besides these retrospective studies there have been many case reports of tumor transmission (melanoma, sarcoma, renal cell carcinoma, etc) (Stephens et al 2000;Milton et al 2006;Neipp et al 2006;Cankovic et al 2006;Detry et al 2005;Morris-Stiff et al 2004;Gerstenkorn and Thomusch 2003;Lipshutz et al 2003;Loren et al 2003;Kakar et al 2002;Barrou et al 2001;Winter et al 2001;Conlon and Smith 1995;Oesterwitz and Lucius 1991;Barnes and Fox 1976), some of which may have been included in the reviews described.…”

“…In one case of liver transplantation for hepatitis B cirrhosis, histological examination of a lung mass found on autopsy showed metastatic adenocarcinoma. Despite urgent re-transplantation within 7 days, the recipient developed metastatic pulmonary adenocarcinoma diagnosed 11 months after transplantation and died soon thereafter (Lipshutz et al 2003). Cell Tissue Banking (2007) 8:267-286 271 Early reports of tumor transmission and the understanding of how the malignancy metastasize lead to the recommendations by Dr. Penn that cancers with late appearance of metastasis like breast, lung, colon should be avoided (Penn 1991).…”

Autotransplantation of cryopreserved ovarian tissue: a procedure with promise, risks, and a need for a registry

“…Organ transplant surgeons have established a registry of transplants from organ donors with a history of cancer (92,93). The cancers at highest risk of being transmitted to recipients include central nervous system tumors, choriocarcinoma, breast cancer, renal carcinoma, and lung cancers (94)(95)(96)(97)(98)(99)(100). The overall risk of death from a donor-derived malignancy is well less than 1% (101,102).…”