A man who underwent a liver transplant to save his life died less than a year later from cancer he caught from his donor.
The unnamed patient, 41, from California, had a chronic liver disease and received a transplant from a deceased donor in 2001 who was later found out to have lung cancer that had gone undetected.
The recipient died from the same lung cancer as his first donor a year later, despite surgeons giving him a second emergency transplant to try and rid him of the disease.
Doctors involved in the case, wrote in their report: ‘Clearly, tumor cells had escaped the confines of the transplanted liver within one week after transplantation and gained access to the general circulation.’
They added that the situation is the ‘first case in the literature of donor cancer transmission’ despite removing the original organ and having the recipient undergo a second transplant.
And the case is one of only a handful in the US where cancer has been transferred between organ donors and recipients.
Doctors believe tiny cancer cells too small to be detected by scans migrated from the donor’s lungs to his liver, which would explain why his organ was declared cancer-free and safe to transplant.
The 41-year-old man underwent a second liver transplant after the donor of his first one was found to have lung cancer (stock photo)
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The patient originally needed a liver transplant because he developed hepatitis B cirrhosis – a chronic liver condition that causes scar tissue to replace healthy tissue in the liver and diminishes function.
The donor was a 63-year-old man who had died from a stroke but had no history of cancer. Lab tests performed prior to transplantation found there were no signs of cancer in the donor’s liver or lungs and chest.
However, when an autopsy was performed on the donor the day after surgery, a tumor was discovered on his lungs.
He was posthumously diagnosed with metastatic pulmonary adenocarcinoma – lung cancer that had spread to the area of his chest between the lungs.
The autopsy findings prompted doctors to relist the patient for another liver, which he received seven days later.
He recovered from the surgery successfully.
For weeks after the second surgery, the patient continued to do well, but because of the donor’s cancer, he underwent a CT scan 10 months after the transplant, which showed no signs of cancer in his chest, abdomen or pelvis.
However, six weeks after the scan, the recipient developed abdominal pain, vomiting and a feeling of fullness.
Blood tests, fluid analysis and body scans revealed metastatic pulmonary adenocarcinoma – the same type of cancer as his first donor.
And the immunosuppressant drugs the patient was given to prevent organ rejection likely fueled the cancer, allowing it to more easily grow and spread – making it even deadlier.
Chemotherapy was prescribed and planned to begin a few weeks later, but a month after his diagnosis, the man developed fluid build up and a blood clot in his legs.
He was admitted to the hospital for treatment but died within 24 hours.
Sample B shows tumor cells in the donor’s right lung and square C shows features in the recipient’s tumor cells, which have ‘features similar to donor tumor cells’
Analysis of the donors’ and the recipient’s cancers ‘corroborates that the first donor was the source of the malignancy.’
Doctors wrote in the case report published in the journal Liver Transplantation that an analysis of the tumor cells from both donors and the recipient ‘showed striking similarities to the pulmonary adenocarcinoma of donor 1.
The recipient’s tumor cells had ‘identical’ features to donor 1’s lung tumor.
Further testing revealed the cancer ‘originated from donor 1, not donor 2 or the recipient himself.’
Cases of ‘transplanted’ cancer are extremely rare and there are no statistics on the subject – only a handful of sporadic cases have been documented in medical literature.
A 2013 review of these cases published in the Cold Spring Harbor Perspectives in Medicine, states there is no estimation of risk for transmitting cancer from donor to recipient and there is limited data on the subject.
Report authors wrote: ‘The incidence of any cancer transmission is so low that sporadic case reports are the main source of information.’
An earlier review from 1993 that looked at data from the 1970s also found there were only ‘sporadic’ reports of cancer being transmitted through organ donation.
The 2013 review added: ‘The low frequency and very variable stage of cancers mean that definitive risk calculations are impossible.’
However, the authors continued, the data is ‘highly likely to underestimate the true incidence.’
Using the limited data available, authors of the 2013 report found cancers known to have been transmitted from donor to recipient on at least one occasion include, breast cancer, colon cancer, liver cancer, lung cancer, melanoma, ovarian cancer, prostate cancer and renal cancer.
