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Adverse Occurrence type:
Most recent risk assessment for Lung Cancer (Council of Europe, 2018): Any form of newly diagnosed lung cancer represents an Unacceptable Risk for organ donation. Treated lung cancer is considered to be High Risk, but this may be modified by curative therapy and recurrence-free time with increasing probability of cure.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Posttransplant follow-up of the lung recipient was unsuspicious in a chest CT-scan at 4 months (for retrosternal pain) and surveillance bronchoscopies at 1 week and 3/6/9 months. Lung recipient presented 13 months after transplant with severe back pain after no obvious injury. Physical examination: local tenderness over the lumbosacral spine and right sacroiliac joint, no lymphadenopathy. Labs: hyponatremia (130 mmol/l), elevated alkaline phosphatase (1.212 IU/l), elevated total and ionized Calcium and CRP (304 mg/l). Plain radiography: sclerotic lesion of the right scapula and right sacral alae. Radioisotope bone scanning: numerous "hot spots" consistent with metastases CT abdomen: intrahepatic masses (biopsy showed metastatic small cell carcinoma) Cyclosporine dose was reduced and analgesic management was started, chemotherapy with carboplatin and etoposide was given. Due to progressive disease, local radiotherapy was administered to the lumbar spine. There was no clinical response to chemotherapy and the patient died 1 month after hospital admission. Autopsy showed multiple liver and bone metastases as well as a single small nodule in the allografted right lung, no macroscopic malignancy in the esophageus.
Demonstration of imputability or root cause:
Since donor and recipient both were men and a simple FISH was not helpful, genetic DNA analysis compared allelic patterns - of the tumor (lung primary, affected liver tissue) - with donor tissue (normal lung tissue) - and with recipient tissue (normal liver tissue, heart tissue) This confirmed donor origin of the tumor by showing that affected liver and primary lung tumor were syngeneic and distinct from recipient heart and non-affected liver.
Suggest new keywords:
Lung cancer, small cell
De Soyza AG, Dark JH, Parums DV, Curtis A, Corris PA. Donor-acquired small cell lung cancer following pulmonary transplantation. Chest. 2001;120(3):1030-1.
First review done on August 5, 2018 (Kerstin) Second review Mike 9/11
Expert comments for publication:
The donor was a 50-year-old man with a 10-pack-year smoking history who stoppped smoking 20 years prior to his death. As the authors state, in times of organ shortage, such donor history should not lead to declining a lung offer but should encourage a very careful donor evaluation and inspection. Since chest x-ray of the donor and the recipient's chest CT-scan 4 months posttransplant did not suggest any pulmonary pathology (also in repeated analysis after confirmation of the recipient tumor), this was a very unfortunate and rapid course of events. Immunosuppression might have accelerated the tumor progression