In a cruel twist of fate, a man undergoing an organ transplant to treat his liver cancer ended up catching a different 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 surgery was successful, however, months later the man developed an aggressive and advanced form of cancer.
Further testing of the cells extracted from the biopsy revealed the cancer was ‘distinctly different’ from the disease the man had before undergoing the liver transplant.
Based on a slew of lab results, doctors determined the new cancer in the liver ‘originated from the donor.’ And while 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 the subject – only a handful of sporadic cases have been documented in medical literature.
Doctors in the case report wrote: ‘To our knowledge, this is the only case in literature describing donor‐derived lung cancer in a liver graft without known malignancy in the donor.’
A patient with cirrhosis and liver cancer underwent a liver transplant, receiving an organ from a deceased donor (stock photo)
The patient had originally needed a liver transplant because he developed alcoholic cirrhosis – liver disease that causes scarring of the organ due to excessive drinking – and hepatocellular carcinoma (HCC), a type of liver cancer.
But body scans did not show signs of cancer anywhere else in the body, doctors wrote in the patient’s case report published in The Oncologist and shared in the NIH’s National Library of Medicine.
While his medical team originally 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. While the masses had not been seen on previous scans, doctors still ruled them ‘indeterminate.’
The patient then underwent a CT scan, which revealed three new masses.
Six weeks later, an MRI showed ‘innumerable liver masses.’
Biopsies confirmed ‘poorly differentiated carcinoma,’ suggesting an aggressive and advanced form of metastatic lung cancer.
Doctors wrote: ‘The… features of the tumor were distinctly different from those of the prior 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 above charts show the genetic makeup of the tumor in the man’s transplanted liver is the same as that of the donor
This suggests 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 did not have a history of lung tumors or cancer.
Further, pre-donation testing did not uncover any tumors and exams of the donor’s lungs did not uncover any causes for concern.
Because of the spread of his cancer, the patient was not eligible to receive another liver transplant and anti-rejection medications – prescribed so his body did not reject his new liver – had to be reduced.
The man received chemotherapy drugs and the cancer appeared to be stabilizing, but a subsequent scan revealed it had progressed beyond treatment. He died approximately six months after his transplant.
Doctors wrote: ‘Progression of [liver] metastases and reduced immunosuppressive agents led to liver failure and the patient’s death.’
The case report stated donor-derived lung cancer in a liver has only ever been reported one other time in a 41-year-old man whose donor was discovered to have lung cancer several days after the transplant.
But this is the first-known case of donor-derived cancer from a donor with no known cancers.
The above images 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 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.
