Donor-Transmitted, Donor-Derived, and De Novo Cancer After Liver Transplant

Abstract

Cancer is the third most common cause of death (after cardiovascular disease and infection) for patients who have a functioning kidney allograft. Kidney and liver transplant recipients have similar cancer risks because of immunosuppression but different risks because of differences in primary diseases that cause renal and hepatic failure and the inherent behavior of cancers in the liver. There are 4 types of cancer that may develop in liver allograft recipients: (1) recurrent cancer, (2) donor-transmitted cancer, (3) donor-derived cancer, and (4) de novo cancer. Identification of potential donor cancer transmission may occur at postmortem examination of a deceased donor or when a probable donortransmitted cancer is identified in another recipient. Donor-transmitted cancer after liver transplant is rare in Australia, the United Kingdom, and the United States. Aging of the donor pool may increase the risk of subclinical cancer in donors. Liver transplant recipients have a greater risk of de novo cancer than the general population, and risk factors for de novo cancer in liver transplant recipients include primary sclerosing cholangitis, alcoholic liver disease, smoking, and increased age. Liver transplant recipients may benefit from cancer screening because they have a high risk, are clearly identifiable, and are under continuous medical supervision.

Epidemiology of de novo malignancies after solid-organ transplantation: Immunosuppression, infection and other risk factors

“…In the case of late tumours (such as 10 years post transplant), it is reasonable that no mass lesion existed at the time of transplant, and for this reason only tumours originating from donor cells arising within 2 years post transplant have to be considered donor-transmitted tumours [35,38].…”

“…Several international organizations have defined a list of recommendations for malignancy screening, which include a complete history of neoplasia, physical examination of skin malignancies, blood testing for the detection of tumour markers (recommending the storage of samples for future analysis), imaging testing, pathological examination of procured organs and routine autopsy; moreover, unexplained intracranial haemorrhage or menstrual disorders in women should be investigated to rule out the presence of underlying oncological diseases [37,38].…”

Outcomes of Organ Transplantation from Donors with a Cancer History

“…The cancer burden for organ transplant recipients is a widely acknowledged issue. Recipients are confronted with a remarkably higher risk of de novo cancer than the general population [ 4 , 5 ]. As shown in Table 3 , recipients of kidney transplants from DWCH had a significantly higher incidence of malignancy at 5 years and 10 years of follow-up than did those receiving transplants from DWNCH.…”

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

“…( 29 ) Therefore, such epidemiological considerations should be taken into account in the perspective of establishing updated guidelines both for management of donors with different characteristics and of recipients with different disease. ( 30 )…”

“…(29) Therefore, such epidemiological considerations should be taken into account in the perspective of establishing updated guidelines both for management of donors with different characteristics and of recipients with different disease. (30) To the best of our knowledge, this is the first systematic review of published data on transmitted cancer in liver transplant recipients. We provide insights on the distribution and prognosis of recipients with transmitted cancers, confirming the worse prognosis of some cancer types and suggesting some important time points for recipients' follow-up.…”