In a cruel twist of fate, a man who underwent an organ transplant to treat his liver cancer ended up contracting another form of the disease and dying.
The unnamed patient, 69, from Arizona, had cirrhosis and received a liver transplant from a deceased donor in 2019.
The transplant was successful, but months later the man developed an aggressive and advanced form of cancer.
Further examination of the cells from the biopsy showed that the cancer was ‘markedly different’ from the disease the man had before he underwent the liver transplant.
Based on a series of laboratory results, doctors determined that the new cancer in the liver “came from the donor.” And although the man was eventually diagnosed with lung cancer, the tumors were, unexpectedly, confined solely to his new liver.
Cases of ‘transplanted’ cancer are extremely rare and there are no statistics on this subject; only a handful of sporadic cases have been documented in the medical literature.
Physicians in the case report wrote, “To our knowledge, this is the only case in the literature describing liver transplant donor lung cancer without known malignancy in the donor.”
A patient with cirrhosis and liver cancer underwent a liver transplant and received an organ from a deceased donor (stock photo)
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The patient originally needed a liver transplant because he developed alcoholic cirrhosis – a liver disease that causes scarring of the organ from excessive drinking – and hepatocellular carcinoma (HCC), a form of liver cancer.
But body scans showed no signs of cancer anywhere else in the body, doctors said wrote in the patient’s case report, published in The Oncologist and shared in the NIH National Library of Medicine.
While his medical team initially tried minimally invasive procedures to cure the cancer, the man developed worsening liver function and a transplant was deemed necessary.
Six months after his initial diagnosis, he underwent a liver transplant at the Mayo Clinic in Phoenix, Arizona.
Four months later, a routine ultrasound revealed two solid masses in his liver. Although the masses had not been seen on previous scans, doctors still ruled them as ‘indeterminate’.
The patient subsequently underwent a CT scan, which revealed three new masses.
Six weeks later, an MRI showed “numerous liver masses.”
Biopsies confirmed ‘poorly differentiated carcinoma’, indicating an aggressive and advanced form of metastatic lung cancer.
Doctors wrote: ‘The… characteristics of the tumor were clearly different from those of the previous HCC. These findings were suspicious for donor-transmitted malignancy.
‘A polymerase chain reaction-based assay [PCR test] strongly suggested that the newly diagnosed metastatic carcinoma in the liver originated from the donor.”
The graphs above show that the genetic makeup of the tumor in the man’s transplanted liver is the same as that of the donor
This suggests that the organ donor had undiagnosed, advanced lung cancer that had spread to his liver.
The 50-year-old male deceased donor had a history of smoking but had no history of lung tumors or cancer.
In addition, pre-donation testing revealed no tumors and examinations of the donor’s lungs revealed no cause for concern.
Due to the spread of his cancer, the patient was ineligible for another liver transplant and the anti-rejection medications – prescribed so his body did not reject his new liver – had to be tapered.
The man was given chemotherapy drugs and the cancer appeared to stabilize, but a subsequent scan revealed that treatment had progressed. He died about six months after his transplant.
Doctors wrote: ‘Progression of [liver] metastases and reduced immunosuppressants led to liver failure and the patient’s death.’
The case report stated that donor-derived lung cancer in the liver was reported only once in a 41-year-old man whose donor was found to have lung cancer several days after the transplant.
But this is the first known case of donor cancer from a donor with no known cancers.
The images above show a CT scan of the liver tumor (top, circled) and an MRI of the liver tumor (bottom, circled)
Transplanted cancer cases are extremely rare.
A 2013 judgement of these cases published in the Cold Spring Harbor Perspectives in Medicine states that there is no estimate of the risk of transmitting cancer from donor to recipient and there are limited data on this topic.
The report’s authors wrote: ‘The incidence of cancer transmission is so low that sporadic case reports are the main source of information.’
One earlier judgement a 1993 study, which looked at data from the 1970s, also found that there were only ‘sporadic’ reports of cancer transmitted through organ donation.
The 2013 review added: ‘The low frequency and highly variable stage of cancer make definitive risk calculations impossible.’
However, the authors went on to say that the data “very likely underestimates the true incidence.”
Using the limited data available, the authors of the 2013 report found that cancers known to have been transmitted from donor to recipient on at least one occasion included breast cancer, colon cancer, liver cancer, lung cancer, melanoma, ovarian cancer, prostate cancer and kidney cancer are. cancer.