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.

Unresectable Squamous Cell Carcinoma of Donor Origin Treated With Immunosuppression Withdrawal and Liver Retransplantation

“…These cases have included donor transmitted neuroendocrine carcinoma (13), Kaposi's sarcoma (17), leiomyosarcoma (16), melanoma (11), adenocarcinomas (18,26), glioblastomas (15,27,28), and choriocarcinomas (12,14,24,25) Our case represents such a case and, to our knowledge, is the only reported case of donor-transmitted SCC occurring in a transplanted liver. Epidermoid cancers have been reported to be transmitted to renal recipients (29).…”

“…There have been very few documented cases of nonlymphoid solid organ tumors of donor origin reported following liver transplantation (11)(12)(13)(14)(15)(16)(17)(18)(24)(25)(26)(27)(28). These cases have included donor transmitted neuroendocrine carcinoma (13), Kaposi's sarcoma (17), leiomyosarcoma (16), melanoma (11), adenocarcinomas (18,26), glioblastomas (15,27,28), and choriocarcinomas (12,14,24,25) Our case represents such a case and, to our knowledge, is the only reported case of donor-transmitted SCC occurring in a transplanted liver.…”

“…Discovery of a donor-derived malignancy in an allograft is a very unusual occurrence following solid organ transplantation. Many of these tumors are lymphoproliferative, however, cases of various nonlymphoid donor-derived malignancies developing in solid organ recipients have also been described (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Establishing the origin of malignancy can be very difficult yet has significant implications for successful treatment.…”

De novo malignancies after liver transplantation: A major cause of late death

“…Penn 84 noted that 117 of 270 recipients of organs from donors with malignancies developed cancer. Jonas et al 85 reported the transmission of a single glioblastoma multiforme of 49 organs transplanted from donors with central nervous system malignancies.…”

Increased mortality after liver transplantation for hepatocellular carcinoma in hepatitis B-associated cirrhosis

“…If the assessment of a graft was considered to be critical, the decision was objectified with a frozen section biopsy. Primary malignancy of the donor -except for selected cases of primary cerebral neoplasiawas an exclusion criterion [5].…”