In an “extraordinary” case, multiple patients in Europe developed cancer after receiving organs from a woman with breast cancer whose malignancy was missed by multiple pre-transplant tests. The patients developed cancer years after their transplant surgeries, and three out of the four ended up dying, according to a case report published in the American Journal of Transplantation.
Although previous reports have shown that cancer cells can be transmitted during an organ transplant, the authors point out that this is the first time this has happened in four patients who received organs from the same person.
The report highlights the potentially life-threatening consequences of donor-derived malignancies. The authors note that doctors can help treat patients by removing the transplanted organ — if possible — and stopping immunosuppression drugs, which prevent rejection.
The donor was a 53-year-old woman who died from a stroke, and whose heart, lungs, liver, and kidneys were donated. There were no signs of a malignancy before the transplant, according to a physical exam, x-rays, and laboratory tests, so the organs were cleared for donation to five patients.
The heart recipient died of sepsis, a serious infection, 5 months after transplantation, according to the report. The four other recipients developed cancer within 16 months to six years after their organ transplants. Three of these patients died after the donor-derived cancer metastasized, or spread from the donated organ to other parts of the body like the bones or brain.
The first to be diagnosed was a double-lung recipient, a 42-year-old-woman, who went to the hospital for transplant problems in 2008. There doctors found cancer cells in her lymph nodes, and DNA testing showed that it was from donor-derived breast cancer cells. The lung transplant patient died a year later, in 2009.
The other patients were warned of the lung recipient's cancer, but for two of them it was too late to successfully be treated. The 62-year-old woman who received the left kidney died in 2013, and a 59-year-old woman who received the liver died in 2014.
The only patient who survived the donor-derived breast cancer was the right kidney recipient, a 32-year-old man.
Doctors treated his cancer by removing the donated kidney, starting chemotherapy, and stopping immunosuppression drugs. These powerful drugs help suppress the immune system, which prevents people from rejecting transplants but also decreases the immune system's ability to fight off infections and cancer. As of 2017, the patient is tumor-free and is seeking another kidney transplant.
The risk of transmitting a malignancy is still very low — between 0.01 and 0.05% for each organ transplant — and current screening methods are pretty effective. However, once the cancer is transmitted from a donor to a recipient, it is very difficult to treat the cancer and there is a very high mortality rate, according to the report.
People who have invasive or active malignancies — except for certain localized tumors or skin cancers — are unsuitable candidates for organ donation, the report authors note. It is unclear whether a CT scan would've revealed this woman's breast cancer cells and prevented the donor-derived cancer cell transmission.