Death from donor-transmitted malignancy despite emergency liver retransplantation.
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.
Lipshutz
Gerald S
GS
Division of Transplantation, Department of Surgery, University of California, San Francisco, CA 94143, USA.
Baxter-Lowe
Lee Ann
LA
Nguyen
Tim
T
Jones
Kirk D
KD
Ascher
Nancy L
NL
Feng
Sandy
S
D000230:Adenocarcinoma / Q000209:etiology* / Q000473:pathology; D000328:Adult; D017809:Fatal Outcome; D019694:Hepatitis B, Chronic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D014019:Tissue Donors