Case report: Donor sarcoma in liver recipient

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for sarcoma (Council of Europe, 2022): Due to the very aggressive behavior of sarcoma, they are considered an unacceptable risk for organ donation at any stage of disease. Sarcoma in donor history: Because of the very aggressive behavior of sarcoma, they are mostly considered an unacceptable risk for organ donation. After curative treatment and a recurrence-free survival of > 5 years, sarcomas are still assumed to be associated with a high risk for transmission.
Time to detection: 
Several days after transplant
Alerting signals, symptoms, evidence of occurrence: 
Donor autopsy showed a spindle cell sarcoma of the aortic arch and two small (1.3 and 0.6 cm) well differentiated renal cell carcinomas involving both kidneys. Following notification, urgent retransplantation was performed 4 days after the first transplant. Review of the original transplant liver showed a 0.9 cm sarcoma metastasis.
Demonstration of imputability or root cause: 
Direct demonstration of donor tumor in the allograft removed 4 days after transplant.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case report
Deceased donor
Liver transplant
Sarcoma, other or type not specified
Suggest references: 
Ortiz JA, Manzarbeitia C, Noto KA, Rothstein KD, Araya VA, Munoz SJ, et al. Extended survival by urgent liver retransplantation after using a first graft with metastasis from initially unrecognized donor sarcoma. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2005;5(6):1559-61.
Carl-Ludwig: agree to MIchael (14-09-2020)
Expert comments for publication: 
Following retransplant, the liver recipient remained well at the time of publication, 76 months after transplant. A second lung recipient from the first donor also underwent urgent retransplant and received a lung from the same second donor. That recipient was reported elsewhere (Kreisel et al Transplantation 2001;71:1859-62) and by personal communication was also well 76 months after transplant. The article demonstrates successful application of retransplantation in this setting. The ability to perform this successfully, and the time frame in which it can be successfully performed, remain open issues.