Donor‐Transmitted Cancers in Transplanted Livers: Analysis of Clinical Outcomes

Abstract

The risk of transmission of malignancy from donor to recipient is low. However, this occurrence has dramatic consequences. Many reports of donor-derived cancers in liver transplant recipients have been published, but they have not been systematically summarized into a lucid and unified analysis. The present study is an attempt to provide clarity to this unusual but clinically important problem. We systematically reviewed all patient reports, patient series, and registries published on cancer transmission events through the end of December 2019. We identified a total of 67 publications with 92 transmission events. The most frequently transmitted cancers were lymphomas (30; 32.6%), melanomas (8; 8.7%), and neuroendocrine tumors (8; 8.7%). Most of the melanomas were metastasizing, whereas most of the lymphomas were localized to the graft. The median time to cancer diagnosis after transplantation was 7 months, with 78.1% of diagnoses established in the first year. Melanoma carried the worst prognosis, with no recipients alive at 1 year after cancer diagnosis. Lymphoma recipients had a better outcome, with more than 75% surviving at 2 years. A metastatic cancer carries a worse prognosis for recipients, and recipients with localized cancer can benefit from the chance to undergo transplantation again. The findings confirm the need to pay attention to donors with a history of melanoma but also suggest the need for a more careful evaluation of groups of donors, such as those dying from cerebral hemorrhage. Finally, recipients of organs from donors with cancer should be carefully followed to detect potential transmission.

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

“…[ 29 ] Indicating the precise percentage of glomerulosclerosis in addition to the specific locations, instead of indicating approximately the range (20%–50%), may be decisive in the organ allocation. Furthermore, while transplantation carries an unavoidable risk of transmission of malignant diseases from donor to recipient,[ 30 31 ] the digital system opens the way to a real-time, fast, and reliable consultation and quality control assessment of diagnoses provided by pathologists in the time constraints of transplant.…”

Long‐term survival after choriocarcinoma transmitted by liver graft: A successful report in pediatric transplantation

“…Transplantation has become an exceptional opportunity not only to treat patients with acute liver failure and end-stage liver disease, but also a way to improve the quality of life and the proper development of children and adolescents with metabolic diseases. 1,2 Posttransplant lymphoproliferative disease and other de novo tumors are well described as a potential complication in LT. 1,8,9 Occult tumors of the graft are fortunately very rare but almost impossible to predict and hard to explain to patients and families. A wide range of experimental findings supports the concept of "immunologic surveillance" where a healthy immune system eliminates the growth potential of the transplanted malignant cells.…”

It is not only extending donor criteria: it is extending the donor pool. A cross‐sectional survey from the European Society of Organ Transplantation

“…In summary, many transplant professionals were willing to accept donors with an additional risk of transmission of infectious or malignant disease although there was no consensus on clinical pathways [1][2][3]. Many centres closed during the height of the pandemic and now have continuation plans in place [4][5][6].…”