Liver graft-transmitted glioblastoma multiforme. A case report and experience with 13 multiorgan donors suffering from primary cerebral neoplasia

Abstract

The transmission of donor-related malignancies by organ transplantation is a rather rare event. There has only been one report on the development of a brain tumor metastasis in liver transplantation. From September 1988 to January 1993, 342 donor hepatectomies with subsequent transplantation were performed at our center. The main donor diagnoses included subarachnoidal bleeding (n = 128; 37.4%), isolated head injury (n = 114; 33.3%), multiple injuries (n = 55; 16.1%), primary cerebral neoplasia (n = 13; 3.8%), and other (n = 32; 9.4%). Primary cerebral neoplasia included glioblastoma (n = 4), meningioma (n = 3), astrocytoma (n = 2), angioma (n = 2), neurocytoma (n = 1), and ependymoma (n = 1). In the group of donors suffering from primary cerebral neoplasia, procured organs other than the liver included kidneys (n = 20), combined kidneys and pancreata (n = 1), pancreata (n = 2), hearts (n = 8), combined hearts and lungs (n = 1), and single lungs (n = 1). Follow-up of the respective graft recipients ranged from 28 to 68 months (median 43 months). Recurrent malignancy was observed once, in a liver graft recipient. The donor, a 48-year-old female, had undergone surgical resection of an intracerebral multiform glioblastoma and died 4 months later of a relapse in the brain stem. The 28-year-old female recipient had undergone transplantation for an autoimmune-hepatitic cirrhosis. Four months later, histopathological examination of an intraperitoneal and intrahepatic mass revealed a poorly differentiated, small-cell pleomorphic cancer, identified as a glioma metastasis by S100- and glial fibrillary acidic protein immunohistochemical staining. The patient died 6 months post-transplantation. On autopsy, no further neoplastic lesions were detected. Our review adds a second reported case of a liver graft-transmitted brain tumor to the literature and the fourth donor-related malignancy after hepatic transplantation in general.

The natural history of extracranial metastasis from glioblastoma multiforme

“…There is a high likelihood that significant stromal differences exist between the CNS and distant organs, such that extracranial glioblastoma metastases are difficult to develop. Lastly, there are reports of extracranial glioblastomas developed in recipients of kidney or liver transplanted from donors with glioblastomas [16][17][18][19]. The immunosuppressants used to prevent rejection of donor organs may further potentiate the development of these tumors in the recipient.…”

Management of the Potential Organ Donor in the ICU

“…Two single-center retrospective case series, involving a total of 132 recipients of organs from 47 donors with CNS tumors, documented a transmission rate of 2.2-3% (91,92). Three large transplant registries have also provided data, albeit conflicting.…”

Donor derived malignancy following transplantation: a review

“…Besides this there were seven reported cases of transmission of primary CNS tumors by 1997 (Lefrancois et al 1987;Morse et al 1990;ValBernal et al 1993;Ruiz et al 1993;Konigsrainer et al 1993;Colquhoun et al 1994;Jonas et al 1996;Bosmans et al 1997). These resulted in procurement of 18 transplantable organs (two kidneys, three hearts, two lungs and one kidney/pancreas).…”

“…They noted that besides the case of transmission of a glioblastoma from one donor to two kidney transplant recipients, there were no other cases of tumor transmission in 34 donors with primary CNS tumors providing 84 organs, thus estimating the risk of tumor transmission of 3% (1/34) and the rate of transmitted tumor of 2% (2/84, Table 3). In 46 recipients of organs from 13 donors with primary brain tumor, Jonas et al (1996) found only a single case of transmission of glioblastoma to a liver transplant recipient. Interestingly there was no tumor transmission in the heart from the same donor.…”