Cancer Transmission From Organ Donors—Unavoidable But Low Risk

Desai, Roopal; Collett, David; Watson, Christopher J.; Johnson, Philip J.; Evans, Tim; Neuberger, James

doi:10.1097/tp.0b013e318272df41

Cited by 120 publications

(127 citation statements)

References 18 publications

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“…Transplanting a solid organ carries an unavoidable, but low risk of transmitting an infectious or neoplastic disease from donor to recipient (82). The risk of donor transmitted malignancies should be weight against the urgency to receive a transplant graft.…”

Section: Secondary Lung Cancer In the Allograftmentioning

confidence: 99%

Lung cancer: a rare indication for, but frequent complication after lung transplantation

Raemdonck¹,

Vos²,

Yserbyt³

et al. 2016

J. Thorac. Dis.

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Lung transplantation is an effective and safe therapy for carefully selected patients suffering from a variety of end-stage pulmonary diseases. Lung cancer negatively affects prognosis, particularly in patients who are no longer candidates for complete resection. Lung transplantation can be considered for carefully selected and well staged lung cancer patients with proven, lung-limited, multifocal, (minimally invasive) adenocarcinoma in situ (AIS) (previously called bronchioloalveolar cell carcinoma) causing respiratory failure. Despite a substantial risk of tumour recurrence (33-75%), lung transplantation may offer a survival benefit (50% at 5 years) with best palliation of their disease. Reports on lung transplantation for other low-grade malignancies are rare. Lung transplant candidates at higher risk for developing lung cancer [mainly previous smokers with chronic obstructive lung disease (COPD) and idiopathic pulmonary fibrosis (IPF) or older patients] should be thoroughly and repeatedly screened for lung cancer prior to listing, and preferably also during waiting list time if longer than 1 year, including the use of PET-CT scan and EBUS-assisted bronchoscopy in case of undefined, but suspicious pulmonary abnormalities. Double-lung transplantation should now replace single-lung transplantation in these high-risk patients because of a 6-9% prevalence of lung cancer developing in the remaining native lung. Patients with unexpected, early stage bronchial carcinoma in the explanted lung may have favourable survival without recurrence. Early PET-CT (at 3-6 months) following lung transplantation is advisable to detect early, subclinical disease progression. Donor lungs from (former) smokers should be well examined at retrieval. Suspicious nodules should be biopsied to avoid grafting cancer in the recipient. Close follow-up with regular visits and screening test in all recipients is needed because of the increased risk of developing a primary or secondary cancer in the allograft from either donor or recipient origin.

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Section: Secondary Lung Cancer In the Allograftmentioning

confidence: 99%

Lung cancer: a rare indication for, but frequent complication after lung transplantation

Raemdonck¹,

Vos²,

Yserbyt³

et al. 2016

J. Thorac. Dis.

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“…Donors with central nervous system malignancies should be carefully evaluated as certain risk factors are associated with malignancy transmission; organs from donors having high grade (Ⅲ or Ⅳ) tumors, ventriculo-systemic shunts or history of extensive cranial surgery that disrupts the blood-brain barrier are associated with a transmission rate of 45% and should not be considered for transplantation; in cases where the underlying etiology of brain death is unclear, a rapid limited brain autopsy should be conducted [37] . Data derived from the United Kingdom Transplant Registry showed that 18 solid organ recipients developed cancer from 16 donors (0.06%): 3 were donor-derived cancer (0.01%) and 15 were donor-transmitted cancer (0.05%) [38] . Of the 15 donor-transmitted cancers, 6 were renal; 5 were lung; 2 were lymphoma; 1 was neuroendocrine, and 1 colon cancer [38] .…”

Section: Malignanciesmentioning

confidence: 99%

“…Data derived from the United Kingdom Transplant Registry showed that 18 solid organ recipients developed cancer from 16 donors (0.06%): 3 were donor-derived cancer (0.01%) and 15 were donor-transmitted cancer (0.05%) [38] . Of the 15 donor-transmitted cancers, 6 were renal; 5 were lung; 2 were lymphoma; 1 was neuroendocrine, and 1 colon cancer [38] . Some recent Italian series have shown no disease transmission with use of grafts from donors with lowgrade malignancies or neoplasms of low metastatic potential [39,40] .…”

Section: Malignanciesmentioning

confidence: 99%

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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“…In 1999, the United Network for Organ Sharing (UNOS) Transplant Tumor Registry began to examine donor malignancy data and in their recent report of donor data between 2000 to 2005 four deaths from donor transmitted malignancies were identified [10]. The reported risk of donor tumor transmission rates have ranged from 0.01% [11] to 0.05% [12].…”

mentioning

confidence: 99%