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.