Single Center Series: Transplantation from Donors with Primary Central Nervous System Tumors

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Record number: 
2080
Adverse Occurrence type: 
Estimated frequency: 
Astrocytomas and Glioblastoma Multiforme (Council of Europe, 2018): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extra-neural metastases from low grade astrocytomas (WHO grade II) are rare, and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of more aggressive malignancy are ruled out. Since astrocytomas have a tendency to relapse with a histologically higher grade of malignancy, new histological examinations should be performed where relapse occurs to regrade the tumour. If the tumor co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high grade and will be associated with an increased risk of transmission. Spontaneous extra-neural metastases of anaplastic astrocytomas and glioblastoma multiforme are rare, but have been observed, and occur more frequently when associated with prior surgical treatment and/or ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma multiforme (WHO grade IV) are considered intermediate to high risk for transmission depending on the different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo- /radiotherapy. CNS Germ Cell Tumors: (Council of Europe 2018): Organs from potential donors with mature teratomas represent a minimal risk of tumour transmission. Organs from donors with other germinal cellular tumours should be considered intermediate to high risk for tumour transmission depending on the different international recommendations which will be adjusted with increasing evidence. The transmission risk is further increased in cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo- /radiotherapy. CNS Sarcoma, Meningeal Sarcoma, or Hemangiopericytoma: (Council of Europe 2018): Organs from potential donors with sarcomas of the CNS (WHO grade IV) and haemangiopericytomas (WHO grade IV) are considered intermediate to high risk for tumour transmission depending on the different international recommendations which will be adjusted with increasing evidence. Organs from potential donors with anaplastic haemangiopericytomas (WHO grade III) without any risk actors are considered low to intermediate risk for tumour transmission. Organs from potential donors with haemangiopericytomas (WHO grade II) without any risk factors represent a minimal risk for tumour transmission. The transmission risk for donors with sarcomas of the CNS and any kind of hemagiopericytoma is further increased in cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo- /radiotherapy. Ependymoma: (Council of Europe 2018): Extra-neural ependymoma metastases occur and the cases observed correspond to recurrent neoplasms or those treated with radiotherapy and/or chemotherapy. The transmission risk of organs from donors with ependymomas is considered to depend upon the histological WHO grade of the tumour. Thus, a low grade (WHO I or II) ependymoma represents a minimal risk of transmission whereas an anaplastic ependymoma (WHO III) will be associated with a low to intermediate risk. The transmission risk is increased (high risk) in cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo- /radiotherapy. Medulloblastoma: (Council of Europe 2018): Childhood medulloblastomas are the CNS primitive tumours that metastasise most frequently outside the CNS. The risk may be increased if prior ventriculo-peritoneal or ventricular-atrial shunts, tumour resection or cranial chemo-/radiotherapy have been performed. Organs from potential donors with medulloblastomas (WHO grade IV) are considered intermediate to high risk for tumour transmission depending on different international recommendations which will be adjusted with increasing evidence. They should be used exclusively for transplants where the recipient’s risk of dying while on the waiting list is greater than the probability of tumour transmission. Meningioma: (Council of Europe, 2018): Extra-neural metastases by histologically benign meningiomas are very rare. Organs from potential donors with these types of tumours have a minimal risk of transmission. Anaplastic or malignant meningiomas (WHO grade III) are more aggressive meningeal tumours that occasionally can be associated with extra-neural metastases. Organs from potential donors with these tumours are considered low to intermediate risk if no risk factors are present. The transmission risk of anaplastic or malignant meningiomas is increased (high risk) in cases with previous interventions such as tumour resection, ​ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy. Oligodendroglioma: (Council of Europe 2018): Low-grade oligodendrogliomas (WHO grade II) represent a minimal risk of tumour transmission. Anaplastic oligodendrogliomas (WHO grade III) without any risk factors are considered low to intermediate risk. Donors with anaplastic oligodendrogliomas (WHO grade III) who have previously undergone interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy, are associated with an increased risk (high risk) of tumour transmission.
Time to detection: 
N/A. No transmissions were observed in 16 liver recipients and 46 kidney recipients with followup.
Alerting signals, symptoms, evidence of occurrence: 
N/A
Demonstration of imputability or root cause: 
Disease known in donors; no transmission was seen in recipients.
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
Malignancy
Donor cancer without transmission
Single center series
Deceased donor
Kidney transplant
Liver transplant
astrocytomas and glioblastomas not further specified (WHO grade 1-4)
Astrocytoma (WHO Grade 1)
Astrocytoma (WHO Grade 2)
Astrocytoma (WHO Grade 3)
Astrocytoma/glioblastoma multiforme (WHO Grade 4)
Meningioma
Medulloblastoma (WHO Grade 4)
Germ cell tumor, other or type not specified
Suggest references: 
Wu JH, Qiao PF, Sun XY, Dong JH, Liao JX, Liu XY, et al. Evaluation and Application of Donors with Primary Central Nervous System Tumors. Clin Transplant. 2019:e13677.
Note: 
Fully agree, is another study providing with cases without transmissions. The authors clearly state that the risk is still not zero for transmissions events.
Expert comments for publication: 
Of the 29 donors with CNS tumors, 17 had pathologic diagnosis to include WHO Grade I: 1 case; Grade 2: 4 cases; grade 3: 2 cases; Grade 4: 10 cases. (WHO grades CNS tumors I-IV, with I representing low grade and IV representing high grade tumors). Tumor types included astrocytoma, anaplastic astrocytoma, glioblastoma, meningioma, medulloblastoma and germ cell tumor. Several donors also had interventions such as shunt placement, chemotherapy, radiotherapy, etc. The authors found no difference in outcome in those who received organs from donors with high risk versus low risk CNS tumors. The current literature strongly suggests that the risk of transmission of CNS tumors has been overestimated in the past and that these individuals may donate organs resulting in successful transplants; however, occasional transmissions are documented and careful consideration of all factors remains necessary.