Rapid screening for malignancy in organ donors: 15‐year experience with the Verona “Alert” protocol and review of the literature

Eccher, Albino; Cima, Luca; Ciangherotti, Andrea; Montin, Umberto; Violi, Paola; Carraro, Amedeo; Tedeschi, Umberto; Nacchia, Francesco; Fior, Francesca; Rostand, Momo; Boschiero, Luigino; D’Errico, Antonietta; Scarpa, Aldo; Casartelli-Liviero, Marilena; Ferrari, G.; Rodini, Viviana; Tomaselli, Elisabetta; Zampicinini, Laura; Vanzo, Francesca; Bovo, Chiara; Feltrin, Giuseppe; Neil, Desley; Brunelli, Matteo

doi:10.1111/ctr.13045

Cited by 16 publications

(16 citation statements)

References 20 publications

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“…This may apply also to lymphoproliferative disease found limited to the graft after transplantation, while it remains of great importance to detect active ongoing lymphoma in the donor that can subsequently spread in the recipient [5]. It is extremely encouraging that the transmission of some cancers, in which there are (17) 47 (20) 42 (18 specific donor guidelines to aid detection [9], namely choriocarcinoma, glioblastoma and NSC lung carcinoma have decreased. Indeed, all reported cases are dating back to the 1990s, before the establishment of guidelines and a critical evaluation of occurred cases [9].…”

Section: Discussionmentioning

confidence: 99%

“…The use of autopsies to assess the donors is decreasing likely due to the cost of performing an autopsy [ 15 ] and a reluctance of the donor’s family, together with the greater availability of imaging techniques. However, autopsy can lead to the discovering of an unsuspected cancer, particularly for malignancies difficult to detect [ 16 , 17 ]. A definitive diagnosis of malignancy may not be possible immediately with frozen section and in most instances can be made within a few days however, allowing early and individualized management/treatment of the recipient, preventing the development of cancer.…”

Section: Discussionmentioning

confidence: 99%

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Donor-transmitted cancer in kidney transplant recipients: a systematic review

et al. 2020

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The transmission of cancer from a donor organ is a rare event but has important consequences. Aim of this systematic review was to summarize all the published evidence on cancer transmission in kidney recipients. We reviewed published case reports and series describing the outcome of recipients with donor-transmitted cancer until August 2019. A total of 128 papers were included, representing 234 recipients. The most common transmitted cancers were lymphoma (n = 48, 20.5%), renal cancer (42, 17.9%), melanoma (40, 17.1%), non-small cell lung cancer (n = 13, 5.6%), neuroendocrine cancers comprising small cell lung cancer (n = 11, 4.7%) and choriocarcinoma (n = 10, 4.3%). There was a relative lack of glioblastoma and gastrointestinal cancers with only 6 and 5 cases, respectively. Melanoma and lung cancer had the worst prognosis, with 5-years overall survival of 43% and 19%, respectively; while renal cell cancer and lymphomas had a favorable prognosis with 5-years overall survival of 93 and 63%, respectively. Metastasis of cancer outside the graft was the most important adverse prognostic factor. Overall reporting was good, but information on donors’ cause of death and investigations at procurement was often lacking. Epidemiology of transmitted cancer has evolved, thanks to screening with imaging and blood tests, as choriocarcinoma transmission have almost abolished, while melanoma and lymphoma are still difficult to detect and prevent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Donor-transmitted cancer in kidney transplant recipients: a systematic review

et al. 2020

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“…For donors with no known history of malignancies, current recommendations are to perform malignancy screening as indicated by age and/or sex. In contrast, a more stringent interpretation of the Italian national guidelines that incorporated histopathological examination led to higher detection rate for donor malignancy . Whether novel screening tests, such as circulating tumor DNA, would be helpful in early detection of malignancy in the future is still unclear but should be studied.…”

Section: Discussionmentioning

confidence: 99%

A Case of Donor-Transmitted Non-Small Cell Lung Cancer After Liver Transplantation: An Unwelcome Guest

et al. 2019

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Cancer transmission with organ donation has been previously reported with a variety of malignancies and organ transplants. The risk of transmission through organ transplantation from donors with a history of previously treated malignancies has been addressed by guidelines from transplant societies. Herein, we report a case of a patient who developed lung cancer confined to the liver after liver transplantation with no known history of malignancy in the donor. The suspicion of donor origin arose after positron emission tomography‐computerized tomography scan showed metastatic lung cancer only involving the transplanted liver without a primary focus. Genetic analysis of the malignant cells confirmed donor origin of the cancer.

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“…Guidelines and recommendations have been published in several countries [ 3 – 6 ] to stratify the risk of cancer transmission of donors with neoplastic potential. Guidelines are mainly based on large registries and sparse case reporting of transmission events, so they cannot cover all the possible findings and situations [ 7 , 8 ]. Indeed, evaluation of deceased donors at procurement can be critical when transplant professionals have to manage cases where an exhaustive medical history is not available or when investigations procedures could not be performed.…”

Section: Introductionmentioning

confidence: 99%

Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management

Eccher¹,

Carraro

Girolami³

et al. 2021

Am J Case Rep

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Patient: Female, 41-year-old Final Diagnosis: Diffuse leiomyomatosis Symptoms: None Medication:— Clinical Procedure: — Specialty: Pathology Objective: Rare disease Background: Guidelines have been designed to stratify the risk of cancer transmission in donors with a history of or ongoing malignancy, although this evaluation is not always straightforward when unexpected and rare lesions are found. Case Report: Here, we present a case of a 41-year-old African female donor who died from a cerebral hemorrhage. Her medical history was unavailable. At procurement, multiple diffuse grayish small nodules were noticed along the peritoneal cavity, some of which were sent to the on-call pathologist for urgent frozen section evaluation. Histology showed a multinodular proliferation of uniform bland-appearing spindle cells, with no evidence of necrosis, nor nuclear atypia or mitoses. The overall picture was consistent with the diagnosis of disseminated peritoneal leiomyomatosis, with overlapping morphology with uterine leiomyoma. Given the rarity of the lesion and the potential for recurrence or malignant degeneration, only the liver and heart were allocated to recipients with life-threatening conditions. The decision was taken in a forcedly limited time and took into account the benefit of transplantation and the risk of disease transmission. Conclusions: This case highlights challenges that transplant teams often have to deal with, as lesions that are difficult to diagnose during donor assessment are usually not covered in guidelines. The acceptance and usage of organs in such cases has to be decided in a team-based fashion, with the collaboration of all the transplant professionals involved to optimally assess the transmission risk, carefully balancing the benefits of transplantation for the recipients and the need to guarantee a reasonable degree of safety.

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Rapid screening for malignancy in organ donors: 15‐year experience with the Verona “Alert” protocol and review of the literature

Abstract: Histopathology is an essential component of the multidisciplinary assessment of donors.

Cited by 16 publications

References 20 publications

Donor-transmitted cancer in kidney transplant recipients: a systematic review

Donor-transmitted cancer in kidney transplant recipients: a systematic review

A Case of Donor-Transmitted Non-Small Cell Lung Cancer After Liver Transplantation: An Unwelcome Guest

Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management

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