Donor Transmission of an Intravascular Large B-Cell Lymphoma in Multiorgan Transplantation: A Case Report From a Rare Pitfall in the Predonation Screening for Donor Disease

Abstract

The prevention of donor-transmitted diseases in solid organ transplantation depends on the thorough screening of donors while maintaining a high level of clinical suspicion. The evolution in these practices reduced the incidence of donor-transmitted tumors to minimal and unexpected events. Nevertheless, the recipients of these exceptional transmissions hold significant clinical consequences, challenging decisions, and poor outcomes. The intravascular large B-cell lymphoma (IVLBCL) is an extremely rare and aggressive tumor with almost exclusive intrasmall vessel growth. Its clinical and morphological features make diagnosing potential deceased donors virtually impossible. We report the case of the post-transplant diagnosis of the transmission of this cancer in a multiorgan kidney and liver transplantation. Following the IVLBCL diagnosis on a routine preimplantation kidney biopsy, the transplanted kidney grafts were removed, and a conservative management approach was adopted for the liver recipient. Histological examination of the kidney grafts revealed multifocal involvement by an IVLBCL neoplasm. Subsequent liver recipient biopsy showed no evidence of the known IVLBCL. After three years of follow-up, both kidney recipients have undergone a second kidney transplant, and the liver recipient continues to demonstrate no signs of the IVLBCL disease.