Transmission of synovial sarcoma from a single multi-organ donor to three transplant recipients: case report

Abstract

Background Transmission of malignancy is a notable problem that cannot always be absolutely predicted at the time of transplantation. In particular, donor-derived transmission of synovial sarcoma in solid-organ transplantation is a rare but catastrophic event. Case presentation We are the first to report three cases of synovial sarcoma transmitted from a single multi-organ donor in China. The donor died of respiratory failure caused by an intrathoracic tumor, which was diagnosed as benign at the time of donation. All three recipients developed synovial sarcoma 3–13 months after transplantation; all three cases were confirmed to be donor transmitted. The liver transplant recipient died of tumor metastasis after partial-allograft hepatectomy. The two renal-transplant recipients survived after comprehensive therapy, including allograft nephrectomy, withdrawal of immunosuppressants and targeted therapy with anlotinib. Conclusions This report highlights the importance of detailed donor assessment, close follow-up and timely treatment of unexpected donor-transmitted malignancy. Although pathology is the most important evidence for the exclusion of donors for malignant potential, it should be combined with tumor type, tumor size and speed of growth. Organs from donors with malignant potential should be discarded. Allograft nephrectomy should be considered after confirmation of renal-allograft synovial sarcoma. Anlotinib for synovial sarcoma seems to be effective and well tolerated during long-term follow-up.

Case report: A successful clinical experience of transplantation of liver and kidney from a donor with myelodysplastic syndromes

“…The risk can be reduced by obtaining a complete medical history for a donor, including malignancy types and cancer-free periods in donor selection criteria. It is also necessary to manage multidisciplinary specialist consultations required to clarify the molecular pathological diagnosis and further assess the biological behavior of the cancer ( 7 , 8 ). In the case reported here, a 39-year-old woman undertook a routine examination and was diagnosed with severe anemia.…”

Molecularly Confirmed Female Donor-Transmitted Lobular Breast Cancer to Male following Renal Transplantation

“…With the confirmation of cancer’s origin, attempts were made to gather additional information from the hospital at which the transplant took place as well as the National Transplant Center (Ministry of Health) about the two deceased kidney donors and their respective additional recipients. Previous studies reported donor-transmitted breast cancer and synovial sarcoma, which were occult at the time of transplant, to several recipients; the authors in both reports used DNA microsatellite imaging to identify cancers’ origin [12, 13]. The strongest evidence for transplanted-related cancer originates from HLA typing of the cancerous cells and cross-referencing with donor HLA typing, along with identifying the same cancer in another recipient or in the donor after death [5].…”