Liver Transplantation from a Living Donor with Early Gastric Cancer

Fujiwara, T.; Sakuma, Y.; Hosoya, Yoshinori; Hojyo, Nobuyuki; Yasuda, Yoshikazu; Nagai, Hideo; Hishikawa, Shuji; Mizuta, Koichi; Kawarasaki, Hideo

doi:10.1111/j.1600-6143.2005.00740.x

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Dense adhesions around the hepatoduodenal ligament caused by lymph node dissection at the time of cancer surgery created technical difficulties during donor surgery. Fujiwara et al 46 described a 42-y-old female donor who was incidentally diagnosed with early gastric cancer during preoperative cancer screening. 46 She underwent simultaneous distal gastrectomy with lymph node dissection and left lateral sectionectomy.…”

Section: Special Considerations For the Living Liver Donormentioning

confidence: 99%

“…Fujiwara et al 46 described a 42-y-old female donor who was incidentally diagnosed with early gastric cancer during preoperative cancer screening. 46 She underwent simultaneous distal gastrectomy with lymph node dissection and left lateral sectionectomy. The risks of liver metastases and circulating cancer cell migration to the liver graft were not null and the ethical issue of combining gastrectomy and hepatectomy in the donor was also taken into consideration.…”

Section: Special Considerations For the Living Liver Donormentioning

confidence: 99%

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Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference

et al. 2021

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As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to have a current or past history of malignancy. The frequency of DTCs is consistently reported at 3-6 cases per 10 000 solid organ transplants, with a similar frequency in the LT setting. A majority of DTCs are occult cancers unknown in the donor at the time of transplantation. Most DTCs are diagnosed within 2 y after LT and are associated with a 51% probability of survival at 2 y following diagnosis. The probability of death is greatest for DTCs that have already metastasized at the time of diagnosis. The International Liver Transplantation Society-Sociedad Española de Trasplante Hepático working group on DTC has provided guidance on how to minimize the occurrence of DTCs while avoiding the unnecessary loss of livers for transplantation both in deceased and living donor LT. The group endorses the Council of Europe classification of risk of transmission of cancer from donor to recipient (minimal, low to intermediate, high, and unacceptable), classifies a range of malignancies in the liver donor into these 4 categories, and recommends when to consider LT, mindful of the risk of DTCs, and the clinical condition of patients on the waiting list. We further provide recommendations to professionals who identify DTC events, stressing the need to immediately alert all stakeholders concerned, so a coordinated investigation and management can be initiated; decisions on retransplantation should be made on a case-by-case basis with a multidisciplinary approach.(Transplantation 2022;106: e12-e29).

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Section: Special Considerations For the Living Liver Donormentioning

confidence: 99%

Section: Special Considerations For the Living Liver Donormentioning

confidence: 99%

Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference

et al. 2021

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“…We greatly appreciate the thoughtful comments of Detry et al relating to our report of liver transplantation from a living donor with early gastric cancer (1). The issues posed herein consist of two ethically important aspects surrounding living-related transplantation: the adequacy of a 'patient' with early cancer as a donor, and the risk of a donor involved in combined surgery simultaneously performing graft procurement plus another major operation.…”

Section: To the Editormentioning

confidence: 99%

Liver Transplantation from a Living Donor with Early Gastric Cancer

Fujiwara¹,

Hosoya²,

Sakuma³

et al. 2005

American Journal of Transplantation

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We greatly appreciate the thoughtful comments of Detry et al. relating to our report of liver transplantation from a living donor with early gastric cancer (1). The issues posed herein consist of two ethically important aspects surrounding living-related transplantation: the adequacy of a 'patient' with early cancer as a donor, and the risk of a donor involved in combined surgery simultaneously performing graft procurement plus another major operation.As Detry et al. maintain, the risk of cancer transmission to the recipient with the graft is not null even if the donor's cancer remains in its early stage. We certainly estimated the risk not as zero but as very low on the basis of the preoperative diagnostics as we discussed in our article. Preoperative evaluation of early gastric cancer in terms of depth of invasion and predictive assessment of metastasis according to the depth of invasion are extremely accurate, though not 100%, thanks to the decades of efforts of endoscopists and mountains of data collected by gastroenterologists and surgeons in our country. Nevertheless, such data have derived from noncompromised patients. As Detry et al. appropriately point out, immunosuppressive recipients are more susceptible to cancer 'metastasis' (transmission) whose risk should increase in synchronous cancergraft surgery due to circulating malignant cells as compared to metachronous graft procurement sometime after cancer resection. Our perception was that the low risk of cancer transmission to the recipient compared to the significant risk of death without transplantation warranted proceeding in this particular circumstance.Regarding the donor's increased risk in concurrent surgery, our article failed to present sufficient data on the safety of combined surgery. According to nationwide surveys (2,3), mortality of gastrectomy for early gastric cancer is satisfactorily low (0-0.6%), and that of hepatic graft procurement in living donors is one in 2668 donors in Japan from 1989 to 2003 (4). Very few data are available on the morbidity and mortality of synchronous surgery combining gastrectomy and hepatectomy mainly due to rarity of cases of gastric cancer with operable hepatic metastases. In this regard, the results of colorectal resection combined with simultaneous hepatectomy for operable deposits in the liver may provide some hints. At our institution the overall mortality of combined resection of colorectal cancer and hepatic lobes was extremely low (0%, 0 of the 35 cases) whether the hepatectomized lobe was left or right. We should not, however, extrapolate from these outcomes the safety of hepatic graft procurement combined with another major surgery. As Detry et al. suggest, hepatic graft procurement, especially from the right lobe, still remains marginal with documented morbidity and mortality, denying additional surgical procedures.

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