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Adverse Occurrence type:
Lymphoma: Most recent risk assessment for lymphoma (Council of Europe, 2018): donors with active lymphoma are considered to represent an unacceptable risk for tumor transmission. Insufficient data exist at present to discriminate among different lymphoma subtypes. Donors with a history of treated lymphoma after a disease-free interval of 5 to 10 years are assumed to represent a high risk for transmission. Leukemia: Most recent risk assessment for leukemia (Council of Europe, 2018): donors with active leukemia are considered to represent an unacceptable risk for tumor transmission. Data at this time do not allow for discrimination of individual types of leukemias. Donors with treated leukemia after a disease-free interval of 5 to 10 years are assumed to represent a high risk for tumor transmission.
Time to detection:
4 weeks after transplant (reevaluation of donor tissues taken at time of transplant)
Alerting signals, symptoms, evidence of occurrence:
Demonstration of imputability or root cause:
Frozen section of lymph node at time of donation was interpreted as reactive hyperplasia. Final diagnosis 4 weeks later was lymphocytic lymphoma/chronic lymphocytic leukemia. Reevaluation of donor kidney biopsies taken at time of transplant also showed LL/CLL (CD38 negative).
Suggest new keywords:
Leukemia, lymphocytic, chronic
Collantes R, Mazuecos A, Garcia T, Gomez-Bravo MA, Pascasio JM, Capote FJ, Castro P. Lymphocytic lymphoma/chronic lymphocytic leukemia in a solid-organ donor: an unestablished risk in elderly donors. Transplantation. 2013 Aug 15;96(3):e14-5. doi: 10.1097/TP.0b013e3182997d11. PMID: 23917688.
Uploaded MN 5/13/22 first review CLFF 5/25/22 2nd review MN 5/29/22 please clone record for liver MPHO type also ok (EP)
Expert comments for publication:
The prevalence of LL/CLL is about 5% in 60-89 yrs. old people. Therefore a certain risk exists for occult hematologic diseases, in this case without clinical relapse of the disease in recipients (Note: Decision by authors was: No graft removal several weeks after transplantation, because this does not prevent possible transmission of lymphoid cells anymore -> conservative approach maintaining the grafts and reducing the immunosuppression and close surveillance). No evidence of active disease present in either the liver or the two kidney recipients at 3 years posttransplant.