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:
10 months after tx, increasing back pain followed by hypercalcemia. X ray shows destruction of 10th thoracic vertebra and 3 osteolytic lessions in the skullcap. Five masses found in the liver by MRI. Biopsy of one of these massess compatible with small cell carcinoma. Immunosuppression stopped and graft removed. 18 months later the patient was doing well.
Demonstration of imputability or root cause:
'-Donor heavy smoker but with no evidence of malignancy. '-Two kidneys removed and transplanted, but only one kidney recipient affected. '-Graft removed with no evidence of tumor. '-DNA fingerprinting analysis shows Y-chromosomal sequences amplified from the tumor tissue in a female patient. Also, the malignancy displayed and allele pattern consisting of alleles from both the female recipient and the male donor as determined from the renal allograft.
Suggest new keywords:
Lung cancer, small cell
Expert comments for publication:
Interesting report, one of several examples in this library of a typically lethal cancer with apparent therapeutic control in this setting.