title: 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.
authors.affiliation: Division of Transplantation, Department of Surgery, University of California, San Francisco, CA 94143, USA.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lipshutz
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Baxter-Lowe
authors.forename: Tim
authors.initials: T
authors.lastname: Nguyen
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Jones
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Ascher
authors.forename: Sandy
authors.initials: S
authors.lastname: Feng
mesh_terms: 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