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Imbimbo C, Nauwerk M, Cammarota T, Beyeler F, Krügel N, Elmer A, Mueller TF, Immer F. Donor Evaluation Tool: A New Technology Improves Donor Enrolment on ICU. Transpl Int 2024; 37:12227. [PMID: 39131790 PMCID: PMC11310011 DOI: 10.3389/ti.2024.12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 07/08/2024] [Indexed: 08/13/2024]
Abstract
Uncertainties on the intensive care unit (ICU) regarding the eligibility of a patient to be a potential deceased organ donor may prevent their referral and enrolment in the pathway for organ donation. Healthcare staff may exclude potential donors for medical reasons, which are no longer applicable. Hence, Swisstransplant implemented a digital donor evaluation tool (DET) in 2021, which allows the local hospital's organ donation coordinator to send a direct request to medical advisors (MA) of the organ procurement organization before excluding potential donors. All 156 requests entered in 2022 were analyzed. 117 patients (75.0%) were primarily accepted by the MA as potential donors. Of those 60 patients (51.3%) became actual organ donors. Main reasons for using the DET were questions regarding malignancies (n = 33, 21.2%), infectious diseases (n = 35, 22.4%) and age/co-morbidities (n = 34, 21.8%). The average age of the actual "DET donor" compared to the regularly enrolled, actual "Non-DET donor" was 65.3 ± 15.8 vs. 56.8 ± 17.5 years, respectively (p = 0.008). On average 1.9 ± 1.1 organs compared to 3.2 ± 1.3 organs were retrieved from DET vs. Non-DET donors. In summary, this new digital donor evaluation tool supports reporting and facilitates eligibility decisions in uncertain, complex donor cases, potentially increasing the number of organ donations.
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Affiliation(s)
- Chiara Imbimbo
- Swisstransplant, National Foundation for Organ Donation and Transplantation, Bern, Switzerland
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2
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Pascual J. Breaking Barriers: Widening the Donor Pool to Embrace In Situ or Thin-invasive Localized Melanomas. Transplantation 2024; 108:1488-1489. [PMID: 38466893 DOI: 10.1097/tp.0000000000004969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Julio Pascual
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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3
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Rosales BM, Hedley J, De La Mata N, Cavazzoni E, Vajdic CM, Thompson JF, Kelly PJ, Wyburn K, Webster AC. Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities. Transplantation 2024; 108:1623-1631. [PMID: 38419163 DOI: 10.1097/tp.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Biovigilance concerns are in tension with the need to increase organ donation. Cancer transmission risk from donor to recipient may be overestimated, as non-transmission events are rarely reported. We sought to estimate melanoma transmission risk in deceased organ donation and identify missed opportunities for donation in an Australian cohort with high melanoma prevalence. METHODS We used a population-based approach and linked deceased organ donors, transplant recipients, and potential donors forgone, 2010-2018, with the Central Cancer Registry (CCR), 1976-2018. We identified melanomas using ICD-O-3 classification, assessed the probability of transmission, and compared suspected melanoma history in potential donors forgone with melanoma notifications in the CCR. RESULTS There were 9 of 993 donors with melanoma in CCR; 4 in situ low-risk and 5 invasive high-to-unacceptable risk. Four were unrecognized before donation. Of 16 transplant recipients at risk, we found 0 of 14 transmission events (2 recipients had insufficient follow-up). Of 35 of 3588 potential donors forgone for melanoma risk alone, 17 were otherwise suitable for donation; 6 of 35 had no melanoma in CCR, 2 of 35 had in situ melanomas and 9 of 35 had thin invasive melanomas (localized, ≤0.8 mm thickness). CONCLUSIONS Our findings contribute to current evidence that suggests donors with melanomas of low metastatic potential may provide an opportunity to safely increase organ donation and so access to transplantation.
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Affiliation(s)
- Brenda Maria Rosales
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - James Hedley
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicole De La Mata
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Elena Cavazzoni
- NSW Health, NSW Organ and Tissue Donation Service, Kogarah, NSW, Australia
| | - Claire M Vajdic
- Faculty of Medicine and Health, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John F Thompson
- Faculty of Medicine and Health, Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney Sydney, NSW, Australia
| | - Patrick J Kelly
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney Sydney, NSW, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, Westmead Hospital, Westmead, NSW, Australia
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Tabbara MM, Riella J, Gonzalez J, Gaynor JJ, Guerra G, Alvarez A, Ciancio G. Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts. Front Surg 2024; 11:1391971. [PMID: 38726469 PMCID: PMC11080618 DOI: 10.3389/fsurg.2024.1391971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications. Methods We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained. Results Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m2 (N = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed. Conclusion PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.
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Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jeffrey J. Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Giselle Guerra
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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Lim WH, Au E, Teixeira-Pinto A, Ooi E, Opdam H, Chapman J, Johnson DW, Kanellis J, Davies CE, Wong G. Donors With a Prior History of Cancer: Factors of Non-Utilization of Kidneys for Transplantation. Transpl Int 2023; 36:11883. [PMID: 38020745 PMCID: PMC10643206 DOI: 10.3389/ti.2023.11883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Cancer transmission from deceased donors is an exceedingly rare but potentially fatal complication in transplant recipients. We aimed to quantify the likelihood of non-utilization of kidneys for transplantation from donors with a prior cancer history. We included all intended and actual deceased donors in Australia and New Zealand between 1989 and 2017. Association between prior cancer history and non-utilization of donor kidneys was examined using adjusted logistic regression. Of 9,485 deceased donors, 345 (4%) had a prior cancer history. Of 345 donors with a prior cancer history, 197 (57%) were utilized for transplantation. Donor characteristics of age, sex and comorbidities were similar between utilized and non-utilized donors with prior cancer. The time from cancer to organ donation was similar between utilized and non-utilized donors, irrespective of cancer subtypes. Donors with a prior cancer history were less likely to be utilized [adjusted OR (95% CI) 2.29 (1.68-3.13)] than donors without prior cancer. Of all actual donors, the adjusted OR for non-utilization among those with prior cancer was 2.36 (1.58-3.53). Non-melanoma skin cancer was the most frequent prior cancer type for utilized and non-utilized potential donors. Donors with prior cancers were less likely to be utilized for transplantation, with no discernible differences in cancer characteristics between utilized and non-utilized donors.
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Affiliation(s)
- Wai H. Lim
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Eric Au
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Esther Ooi
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Helen Opdam
- DonateLife, Organ and Tissue Authority, Canberra, NSW, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - David W. Johnson
- Princess Alexandra Hospital, Metro South Integrated Nephrology and Transplant Services, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Germaine Wong
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia
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Brady JE, Tamburro L, Joy AG, Ugarte RM. Donor Origin Neuroendocrine Cancer: A Case Report and Literature Review. Transplant Direct 2023; 9:e1524. [PMID: 37575954 PMCID: PMC10414708 DOI: 10.1097/txd.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- James E. Brady
- Division of General Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Lo Tamburro
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Abel G. Joy
- Division of General Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Richard M. Ugarte
- Department of Medicine, Division of Nephrology, University of Maryland, Baltimore, MD
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Fernandes EDSM, Almeida TRRD, Correa RR, Braga EP, Girão CL, Pimentel LS, Andrade RDO, Mello FPTD, Carvalho ACG, Peres MC, Queiroz CT, Basto ST. URGENT LIVER RETRANSPLANTATION DUE TO TRANSMISSION OF INTRAHEPATIC CHOLANGIOCARCINOMA BY DONOR: THE FIRST REPORT IN THE LITERATURE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1740. [PMID: 37436209 DOI: 10.1590/0102-672020230022e1740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors. AIMS To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver. METHODS A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation. RESULTS After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks. CONCLUSIONS The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.
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Affiliation(s)
- Eduardo de Souza Martins Fernandes
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Department of Transplant Surgery - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | | | | | - Eduardo Pinho Braga
- DASA Hospital São Lucas Copacabana, Department of Pathology - Rio de Janeiro (RJ), Brazil
| | - Camila Liberato Girão
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | - Leandro Savattone Pimentel
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | - Ronaldo de Oliveira Andrade
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | - Felipe Pedreira Tavares de Mello
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | | | - Mariana Coelho Peres
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
| | - Camila Tobias Queiroz
- DASA Hospital São Lucas Copacabana, Department of Pathology - Rio de Janeiro (RJ), Brazil
| | - Samanta Teixeira Basto
- São Lucas Copacabana Hospital, Liver Transplant - Rio de Janeiro (RJ), Brazil
- Adventista Silvestre Hospital, Liver transplant - Rio de Janeiro (RJ), Brazil
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Eccher A, Malvi D, Novelli L, Mescoli C, D'Errico A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clin Pract 2023; 13:610-615. [PMID: 37218806 DOI: 10.3390/clinpract13030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Second opinion consultation is a well-established practice in different clinical settings of diagnostic medicine. However, little is known about second opinion consultation activity in transplantation, and even less is known about it concerning donor assessment. The consultations provided by the second opinion service led to the safer and homogeneous management of donors with a history of malignancy or ongoing neoplasm by transplant centers. Indeed, two of the most important aspects are the reduction of semantic differences in cancer reporting and the standardization of procedures, which are mainly due to the different settings and logistics of different pathology services. This article aims to discuss the role and the future of the second opinion in Italy during organ procurement, highlighting the critical issues and areas for improvement.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics and Public Health, Section of Pathology, University Hospital of Verona, 37136 Verona, Italy
- Second Opinion, National Transplant Center, 00161 Rome, Italy
| | - Deborah Malvi
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Novelli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, 50134 Florence, Italy
| | - Claudia Mescoli
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, 35128 Padua, Italy
| | - Antonietta D'Errico
- Second Opinion, National Transplant Center, 00161 Rome, Italy
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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9
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Sommer W, Franz M, Aburahma K, Saipbaev A, Flöthmann K, Yablonski P, Avsar M, Tudorache I, Greer M, Haverich A, Welte T, Kuehn C, Salman J, Warnecke G, Ius F. Lungs From Donors ≥70 Years of Age for Transplantation-Do Long-Term Outcomes Justify Their Use? Transpl Int 2023; 36:11071. [PMID: 37125386 PMCID: PMC10133456 DOI: 10.3389/ti.2023.11071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023]
Abstract
Donor shortages have led transplant centers to extend their criteria for lung donors. Accepting lung donors ≥70 years of age has previously shown good short-term outcomes; however, no mid- and long-term outcome data on these extended criteria donors has been published to date. In this study, all patients who underwent lung transplantation between 06/2010 and 12/2019 were included in the analysis, and the outcomes were compared between patients receiving organs from donors <70 years of age and patients transplanted with lungs from donors ≥70 years of age. Among the 1,168 lung-transplanted patients, 62 patients received lungs from donors ≥70 years of age. The recipient age of those receiving older organs was significantly higher, and they were more likely to suffer from obstructive lung disease. Older donors were exposed to significantly shorter periods of mechanical ventilation prior to donation, had higher Horowitz indices, and were less likely to have smoked. The postoperative time on mechanical ventilation, time on ICU, and total hospital stay were comparable. The overall survival as well as CLAD-free survival showed no differences between both groups in the follow-up period. Utilization of lungs from donors ≥70 years of age leads to excellent mid- and long-term results that are similar to organs from younger donors when the organs from older donors are carefully preselected.
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Affiliation(s)
- Wiebke Sommer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
| | - Maximilian Franz
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Akylbek Saipbaev
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Flöthmann
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Yablonski
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University of Duesseldorf, Duesseldorf, Germany
| | - Mark Greer
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
| | - Fabio Ius
- German Center for Lung Research, Deutsches Zentrum Lungenforschung (DZL), BREATH, Hannover, Germany
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
- *Correspondence: Fabio Ius,
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10
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Lapointe M, Kerbaul F, Meckert F, Cognard N, Mathelin C, Lodi M. [Breast cancer and organ transplantation: Systematic review and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:60-72. [PMID: 36375787 DOI: 10.1016/j.gofs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Affiliation(s)
- M Lapointe
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - F Kerbaul
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - F Meckert
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - N Cognard
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
| | - M Lodi
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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11
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Tu SM, Moran C, Norton W, Zacharias NM. Stem Cell Theory of Cancer: Origin of Metastasis and Sub-clonality. Semin Diagn Pathol 2023; 40:63-68. [PMID: 35729019 DOI: 10.1053/j.semdp.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 01/28/2023]
Abstract
Metastasis may be the secret weapon cancer uses to dominate and subjugate, to persist and prevail. However, it is no longer a secret when we realize that a stem cell has the same ways and means to fulfill its own omnipotence and accomplish its own omnipresence… and when we realize that a cancer cell has its own version of stem-ness origin and stem-like nature. In this perspective, we discuss whether stem-ness enables metastasis or mutations drive metastasis. We ponder about low-grade versus high-grade tumors and about primary versus metastatic tumors. We wonder about stochasticity and hierarchy in the genesis and evolution of cancer and of metastasis. We postulate that metastasis may hold the elusive code that makes or breaks a stem-cell versus a genetic theory of cancer. We speculate that the vaunted model of multistep carcinogenesis may be in error and needs some belated remodeling and a major overhaul. We propose that subsequent malignant neoplasms from germ cell tumors and donor-derived malignancies in organ transplants are quintessential experiments of nature and by man that may eventually empower us to elucidate a stem-cell origin of cancer and metastasis. Unfortunately, even the best experiments of cancer and of metastasis will be left unfinished, overlooked, or forgotten, when we do not formulate a proper cancer theory derived from pertinent and illuminating clinical observations. Ultimately, there should be no consternations when we realize that metastasis has a stem-cell rather than a genetic origin, and no reservations when we recognize that metastasis has been providing us some of the most enduring tests and endearing proofs to demonstrate that cancer is indeed a stem-cell rather than a genetic disease after all.
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Affiliation(s)
- Shi-Ming Tu
- Division of Hematology and Oncology, University of Arkansas for Medical Sciences.
| | - Cesar Moran
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center.
| | - William Norton
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center.
| | - Niki M Zacharias
- Department of Urology - Research, The University of Texas MD Anderson Cancer Center.
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12
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Marchionni L, Lobo FP, Kostadinov R, Serra A, Besso FG, Deaglio S, Stratta P, Berrino M, Zanettini C, Imada EL, Omar MN, Gaidano G, Bruno B, Saglio G, Amoroso A. Donor-derived acute myeloid leukemia in solid organ transplantation. Am J Transplant 2022; 22:3111-3119. [PMID: 35979657 PMCID: PMC9897593 DOI: 10.1111/ajt.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
We report the transmission of acute myeloid leukemia (AML) undetected at donation from a deceased organ donor to two kidneys and one liver recipients. We reviewed the medical records, and performed molecular analyses and whole exome sequencing (WES) to ascertain AML donor origin and its molecular evolution. The liver recipient was diagnosed 11 months after transplantation and died from complications 2 months later. The two kidney recipients (R1 and R2) were diagnosed 19 and 20 months after transplantation and both received treatment for leukemia. R1 died of complications 11 months after diagnosis, while R2 went into complete remission for 44 months, before relapsing. R2 died 10 months later of complications from allogenic bone marrow transplantation. Microsatellite analysis demonstrated donor chimerism in circulating cells from both kidney recipients. Targeted molecular analyses and medical records revealed NPM1 mutation present in the donor and recipients, while FLT3 was mutated only in R1. These findings were confirmed by WES, which revealed additional founder and clonal mutations, and HLA genomic loss in R2. In conclusion, we report the first in-depth genomic analysis of AML transmission following solid organ transplantation, revealing distinct clonal evolution, and providing a potential molecular explanation for tumor escape.
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Affiliation(s)
- Luigi Marchionni
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francisco Pereira Lobo
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rumen Kostadinov
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Serra
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Federico Genzano Besso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Silvia Deaglio
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Piero Stratta
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Berrino
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Zanettini
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Eddie Luidy Imada
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed N. Omar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Antonio Amoroso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
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13
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Hellström V, Tufveson G, Loskog A, Bengtsson M, Enblad G, Lorant T. Donor-derived urologic cancers after renal transplantation: A retrospective non-randomized scientific analysis. PLoS One 2022; 17:e0271293. [PMID: 36129920 PMCID: PMC9491581 DOI: 10.1371/journal.pone.0271293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Malignancies in the urinary tract and the kidney graft are quite common after kidney transplantation. In some selected cases tumours develop from donor-derived tissue. Objectives We hypothesised that there is a clinical value to investigate donor/recipient origin in urologic malignancies in renal transplant recipients. Methods In this retrospective study, including patients transplanted between the years 1969 and 2014 at Uppsala University Hospital, Sweden, 11 patients with malignancies in urinary tract and 4 patients with malignancies in kidney transplants were investigated. Donor/recipient origin of tumour tissue was analysed by polymerase chain reaction (PCR) of human leucocyte antigen (HLA) genotypes or by fluorescence in situ hybridization (FISH analysis) of sex chromosomes. HLA genotype and sex chromosomes of the tumour were compared to the known HLA genotype and sex chromosomes of recipient and donor. Results Three of ten cancers in the urinary tract and three of four cancers in the kidney transplants were donor-derived. Conclusions We suggest that urologic malignancies in renal transplant recipients can be investigated for transplant origin. In addition to conventional therapy the allograft immune response against these tumours can be valuable to treat donor-derived cancers.
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Affiliation(s)
- Vivan Hellström
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden
- * E-mail:
| | - Gunnar Tufveson
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Angelica Loskog
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Bengtsson
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Tomas Lorant
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden
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14
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Altundag O. Solid-Organ Transplantation From Deceased and Living Donors With Cancer or a History of Cancer. EXP CLIN TRANSPLANT 2022; 20:51-58. [DOI: 10.6002/ect.donorsymp.2022.l30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Aghsaeifard Z, Latifi M, Bagherpour F, Rahbar M, Rahimzadeh H, Namdari F, Dialameh H, Taheri Mahmoudi M, Dehghani S. Choriocarcinoma transmitted with the transplant: Case study. SAGE Open Med Case Rep 2022; 10:2050313X221087567. [PMID: 35449531 PMCID: PMC9016535 DOI: 10.1177/2050313x221087567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/27/2022] [Indexed: 11/15/2022] Open
Abstract
Choriocarcinoma is a rare kind of cancer, which may be either gestational or non-gestational. Choriocarcinoma is responsible for about a quarter of all documented neoplastic aneurysms. It is a descriptive case report of choriocarcinoma transmission from a donor, following kidney donation. A 45-year-old woman got a kidney from a 25-year-old woman who was taken to the hospital due to a non-traumatic cerebral hemorrhage. She delivered a healthy baby 48 days before her brain death. The transplant was successfully done. Five weeks’ post-transplantation, the recipient had pain and erythema in the surgical area. Regarding the high level of beta-human chorionic gonadotropin in her blood, diagnostic tests were performed. Following the confirmation of the cancer, a five-phase chemotherapy plan with various pharmaceutical regimens was initiated. Liver function test values rose after the final round of chemotherapy, and the patient developed hepatic encephalopathy. Considering the thrombocytopenia, dialysis, or hemoperfusion, which are normally performed to reduce liver enzymes, were not initiated. Finally, she died due to the hepatic failure and disseminated intravascular coagulation. Although the nephrologists disagree on the optimal course of treatment, it seems that nephrectomy would be helpful in such instances. Physicians should be aware of the possibility of transplant-related choriocarcinoma in female donors of reproductive age who die because of intracerebral brain hemorrhage for unclear reasons. Every donor must undergo a thorough examination. It is critical to get documents, clarify history, and interview relatives.
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Affiliation(s)
- Ziba Aghsaeifard
- Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Marzieh Latifi
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farzaneh Bagherpour
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Rahbar
- Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hormat Rahimzadeh
- Department of Nephrology Disease, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farshad Namdari
- Department of Urology, AJA University of Medical Sciences, Tehran, Iran
| | - Hossein Dialameh
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohsen Taheri Mahmoudi
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sanaz Dehghani
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciencies, Tehran, Iran
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16
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Mahíllo B, Martín S, Molano E, Navarro A, Castro P, Pont T, Andrés A, Galán J, López M, Oliver E, Martínez A, Mosteiro F, Roque R, Pérez-Redondo M, Cid-Cumplido M, Ballesteros MA, Daga D, Quindós B, Sancho M, Royo-Villanova M, Bernabé E, Muñoz R, Chacón JI, Coll E, Domínguez-Gil B. Malignancies in Deceased Organ Donors: The Spanish Experience. Transplantation 2022; 106:1814-1823. [DOI: 10.1097/tp.0000000000004117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Domínguez-Gil B, Moench K, Watson C, Serrano MT, Hibi T, Asencio JM, Van Rosmalen M, Detry O, Heimbach J, Durand F. Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference. Transplantation 2022; 106:e12-e29. [PMID: 34905759 DOI: 10.1097/tp.0000000000003995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
| | - Kerstin Moench
- Donor Transplant Coordination Unit, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Christopher Watson
- The Roy Calne Transplant Unit and Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - M Trinidad Serrano
- Hepatology Section, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - José M Asencio
- Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | | | - François Durand
- Hepatology Department, Liver Intensive Care Unit, Hospital Beaujon, Clichy, France
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18
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Cancer Diagnosis During Kidney Donor Evaluation. Transplant Proc 2022; 54:537-539. [DOI: 10.1016/j.transproceed.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022]
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19
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Validation of portable tablets for transplant pathology diagnosis according to the College of American Pathologists’ Guidelines. Acad Pathol 2022; 9:100047. [PMID: 35941875 PMCID: PMC9356034 DOI: 10.1016/j.acpath.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Despite increased use of digital pathology, its application in the transplantation setting remains limited. One of the restraints is related to concerns that this technology is inadequate for supporting diagnostic work. In this study, we sought to establish non inferiority of whole slide imaging (WSI) to light microscopy (LM) for intraoperative transplantation diagnosis using inexpensive portable devices. A validation study was conducted according to updated guidelines from the College of American Pathologists (CAP) utilizing 80 intraoperative transplantation cases. Two pathologists reviewed glass slides with LM and digital slides on two different tablets after a washout period of 4 weeks. Diagnostic concordance and intra-observer agreement were recorded. A total of 45 (56%) cases were suitable for rendering transplant diagnoses and 35 (44%) for assessing cancer risk. Intra-observer agreement was 95.1% for organ suitability and 100% for cancer risk. There were no major discordances that could affect patient transplant management. Digital evaluation of intraoperative transplant specimens using tablets to view whole slide images was non-inferior to LM for primary diagnosis. This suggests that after validating WSI these digital tools can be safely used for remote intraoperative transplantation diagnostic work.
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20
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Anderson TL, Brandts HM, Gunderson T, Fazzio RT, Hunt KN, Heimbach JK, Glazebrook KN. Breast cancers observed in transplant patients in a single institution. Clin Imaging 2021; 76:26-29. [PMID: 33548889 DOI: 10.1016/j.clinimag.2021.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Document occurrence of breast cancer in females after liver, kidney, or pancreas transplantation seen at a tertiary medical center. METHODS Medical records of adult female patients with liver, kidney, or pancreas transplants from 1/1/1995 to 4/4/2014 were retrospectively reviewed. Patients with a history of breast cancer, no mammogram post-transplant, or no research authorization were excluded. Mammogram findings and pathology results were reviewed and recorded. Cancer rates could not be measured in patients followed up outside the institution. Descriptive statistics summarized the cohort. Occurrence rates were estimated using Poisson regression. RESULTS 1095 women were included and 33 were diagnosed with breast cancer post-transplant. Median age at diagnosis was 58 years. Average interval from transplant to cancer diagnosis was 82.6 months. Observed occurrence of invasive and in-situ breast cancer (reported as per 100,000 person-years [95% confidence interval]) was 353 [243-496]. Liver transplant patients showed the lowest rate (181 [95% CI 73-372]), vs. kidney (476 [305-708]) or pancreas (467 [57-1688]). Patients with the highest breast density showed increased occurrence despite younger age (1001 [367-2178]) compared to those with lower breast density (range 239 [109-454] to 372 [186-666]). CONCLUSIONS Female patients after organ transplant experienced increased breast cancer occurrence in this observational study. Those who developed breast cancer also had increased breast density. The findings underscore the importance of breast cancer screening in this population.
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Affiliation(s)
- Tara L Anderson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America.
| | - Hannah M Brandts
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Tina Gunderson
- Division of Biostatistics and Infomatics, Mayo Clinic, 200 First Street SW, Rochester, MN, United States of America
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Katie N Hunt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
| | - Julie K Heimbach
- Department of Transplantation Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
| | - Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States of America
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21
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Eccher A, Girolami I, Marletta S, Brunelli M, Carraro A, Montin U, Boggi U, Mescoli C, Novelli L, Malvi D, Lombardini L, Cardillo M, Neil D, D'Errico A. Donor-Transmitted Cancers in Transplanted Livers: Analysis of Clinical Outcomes. Liver Transpl 2021; 27:55-66. [PMID: 32746498 DOI: 10.1002/lt.25858] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Amedeo Carraro
- General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Umberto Montin
- General Surgery Unit, ULSS1 Dolomiti Hospital of Feltre, Feltre, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, Padua, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Deborah Malvi
- Pathology Unit, Sant'Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Letizia Lombardini
- National Health Institute, Rome, Italy.,National Transplant Center, Rome, Italy
| | | | - Desley Neil
- University Hospital Birmingham, Birmingham, United Kingdom
| | - Antonietta D'Errico
- Pathology Unit, Sant'Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
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22
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Ambrosi F, Ricci C, Malvi D, Cillia CD, Ravaioli M, Fiorentino M, Cardillo M, Vasuri F, D'Errico A. Pathological features and outcomes of incidental renal cell carcinoma in candidate solid organ donors. Kidney Res Clin Pract 2020; 39:487-494. [PMID: 32855366 PMCID: PMC7770991 DOI: 10.23876/j.krcp.20.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background We report the findings of a single Italian center in the evaluation of renal lesions in deceased donors from 2001 to 2017. In risk evaluation, we applied the current Italian guidelines, which include donors with small (< 4 cm, stage pT1a) renal carcinomas in the category of non-standard donors with a negligible risk of cancer transmission. Methods From the revision of our registries, 2,406 donors were considered in the Emilia Romagna region of Italy; organs were accepted from 1,321 individuals for a total of 3,406 organs. Results The evaluation of donor safety required frozen section analysis for 51 donors, in which a renal suspicious lesion was detected by ultrasound. Thirty-two primary renal tumors were finally diagnosed 26 identified by frozen sections and 6 in discarded kidneys. The 32 tumors included 13 clear cell renal cell carcinomas (RCCs), 6 papillary RCCs, 6 angiomyolipomas, 5 oncocytomas, 1 chromophobe RCC, and 1 papillary adenoma. No cases of tumor transmission were recorded in follow-up of the recipients. Conclusion Donors with small RCCs can be accepted to increase the donor pool. Collaboration in a multidisciplinary setting is fundamental to accurately evaluate donor candidate risk assessment and to improve standardized protocols for surgeons and pathologists.
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Affiliation(s)
- Francesca Ambrosi
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Costantino Ricci
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo De Cillia
- Emilia-Romagna Transplant Reference Centre, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Transplant Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Francesco Vasuri
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonia D'Errico
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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23
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Zhu M, Bian Y, Jiang J, Lei T, Shu K. Rapid screening for safety of donation from donors with central nervous system malignancies. Medicine (Baltimore) 2020; 99:e22808. [PMID: 33285676 PMCID: PMC7717844 DOI: 10.1097/md.0000000000022808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
With the increasing demand on organ transplants, it has become a common practice to include patients with primary central nervous system (CNS) malignancies as donors given the suggested low probability metastatic spread outside of the CNS. However, an extra-CNS spread of the disease cannot be excluded raising potential risks of cancer transmission from those donors. In order to balance between the risk of donor-derived disease transmission and the curative benefit for the recipient, a careful donor and organ selection is important. We performed a literature research and summarized all reported studies of organ transplants from donors suffered from primary CNS malignancies and determined the risk of tumor transmission to recipients. There were 22 cases of transplant-transmitted CNS tumors onto recipients since 1976. The association risks of cancer transmission were attributed to donor tumor histology, disruption of the blood-brain barrier, cerebrospinal fluid extra-CNS, and false diagnosis of primary intracranial tumor as well as the molecular properties of the primary tumor such as the existence of EGFR-amplification. The association risks and features of CNS tumors transmission recipients indicated that we need to reassess our thresholds for the potential fatal consequences of these donors.
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Affiliation(s)
| | | | - Jipin Jiang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
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24
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Neuberger J, Callaghan C. Organ utilization - the next hurdle in transplantation? Transpl Int 2020; 33:1597-1609. [PMID: 32935386 DOI: 10.1111/tri.13744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision-making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.
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Affiliation(s)
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital and the Evelina London Children's Hospital, London, UK
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25
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Eccher A, Girolami I, Brunelli M, Novelli L, Mescoli C, Malvi D, D'Errico A, Luchini C, Furian L, Zaza G, Cardillo M, Boggi U, Pantanowitz L. Digital pathology for second opinion consultation and donor assessment during organ procurement: Review of the literature and guidance for deployment in transplant practice. Transplant Rev (Orlando) 2020; 34:100562. [PMID: 32576430 DOI: 10.1016/j.trre.2020.100562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023]
Abstract
Telepathology has been an important application for second opinion consultation ever since the introduction of digital pathology. However, little is known regarding teleconsultation for second opinion in transplantation. There is also limited literature on telepathology during organ donor procurement, typically utilized when general pathologists on-call request back-up to help assess donor biopsies for organ suitability or to diagnose newly discovered tumors with urgent time constraints. In this review, we searched Pubmed/Embase and websites of transplant organizations to collect and analyze published evidence on teleconsultation for donor evaluation and organ procurement. Of 2725 records retrieved using the key terms 'telepathology', 'second opinion' and 'transplantation', 26 suitable studies were included. Most records were from North America and included validation studies of telepathology being used for remote frozen section interpretation of donor biopsies with whole slide imaging. The data from these published studies supports the transition towards digital teleconsultation in transplant settings where consultations among pathologists are still handled by pathologists being called on site, via telephone and/or email.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Institute for Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Claudia Mescoli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University and Hospital Trust of Padua, Padua, Italy
| | - Deborah Malvi
- Pathology Unit, University of Bologna, Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonia D'Errico
- Pathology Unit, University of Bologna, Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University and Hospital Trust of Padua, Padua, Italy
| | - Gianluigi Zaza
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside Hospital, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Eccher A, Girolami I, Motter JD, Marletta S, Gambaro G, Momo REN, Nacchia F, Donato P, Boschiero L, Boggi U, Lombardini L, Cardillo M, D'Errico A, Neil D, Segev DL, Zaza G. Donor-transmitted cancer in kidney transplant recipients: a systematic review. J Nephrol 2020; 33:1321-1332. [PMID: 32535833 PMCID: PMC7701067 DOI: 10.1007/s40620-020-00775-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Albino Eccher
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy.
| | - Ilaria Girolami
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
| | | | - Stefano Marletta
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy
| | - Giovanni Gambaro
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | | | - Francesco Nacchia
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Paola Donato
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Letizia Lombardini
- National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Massimo Cardillo
- National Transplant Center, Italian National Institute of Health, Rome, Italy
| | - Antonietta D'Errico
- Pathology Unit, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Desley Neil
- Department of Histopathology, University Hospital Birmingham, National Health Service Foundation Trust, Birmingham, UK
| | - Dorry Lidor Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Gianluigi Zaza
- Renal Unit, University and Hospital Trust of Verona, Verona, Italy
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Neuberger J. Liver Transplantation for Alcoholic Liver Disease: What Is the Risk and Consequence of Relapse? Dig Dis Sci 2020; 65:1600-1607. [PMID: 32060813 DOI: 10.1007/s10620-020-06127-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although short- and medium-term outcomes after liver transplantation for alcohol-related liver disease (ARLD) are generally excellent and similar to outcomes for transplantation for other indications, a return to alcohol consumption commonly occurs even though rates of alcohol consumption after transplantation for ARLD are comparable to those seen in other indications. Transplant recipients should be questioned about alcohol use post-transplantation and, where appropriate, monitored; those drinking significant amounts should be offered treatment with the help of a multi-disciplinary team. Although short-term significant alcohol use is associated with an increased risk of non-compliance and rejection, medium-term outcomes are similar to other groups. Patients transplanted for ARLD have a greater risk of some de novo malignancies, especially of the lung and the upper GI tract. More work is required both to identify those at risk of a return to destructive patterns of alcohol use at an early stage and to develop effective treatments aimed at reaching and maintaining abstinence.
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Affiliation(s)
- James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
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28
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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29
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Eccher A, Girolami I, D’Errico A, Zaza G, Carraro A, Montin U, Boggi U, Scarpa A, Brunelli M, Martignoni G, Segev D, Rossi ED, Pantanowitz L. Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation. Prog Transplant 2019; 29:316-320. [DOI: 10.1177/1526924819873898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.
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Affiliation(s)
- Albino Eccher
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy
| | - Ilaria Girolami
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy
| | - Antonia D’Errico
- Pathology Unit, Department of Specialised, Experimental and Diagnostic Medicine, S. Orsola-Malpighi University Hospital of Bologna, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Italy
| | - Amedeo Carraro
- General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Italy
| | - Umberto Montin
- General Surgery Unit, ULSS1 Dolomiti Hospital of Feltre, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy
| | - Guido Martignoni
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy
- Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Dorry Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Agostino Gemelli School of Medicine, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, PA, USA
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30
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Gioco R, Corona D, Agodi A, Privitera F, Barchitta M, Giaquinta A, Alba I, D'Errico S, Pinto F, De Pasquale C, Pistorio ML, Veroux P, Veroux M. De Novo Cancer Incidence and Prognosis After Kidney Transplantation: A Single Center Analysis. Transplant Proc 2019; 51:2927-2930. [PMID: 31607617 DOI: 10.1016/j.transproceed.2019.04.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/30/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Malignancy is an important cause of mortality in renal transplants recipients. The aim of this study was to evaluate the incidence, prognosis, and survival of patients developing a de novo post-transplant cancer. METHODS Using a retrospective cohort design, we evaluated the incidence of de novo cancers among kidney transplants patients in our hospital from January 2000 to December 2012. We also evaluated the patient survival after tumor diagnosis. RESULTS We included 535 kidney transplants recipients with a mean follow-up of 7.8 years; among them, 39 (7.2%) developed malignancies. Median time from transplant to cancer diagnosis was 3 years, with a median age at diagnosis of 60 years. Male patients were significantly older at time of cancer diagnosis (68.5 years) compared with women (38 years, P < .05), and cancer diagnosis occurred significantly earlier in men (3.5 years since transplantation) than in women (8.5 years, P < .05). Among 39 patients affected by a de novo post-transplant cancer, 18 patients (46.2%) died, with an average age at death of 58.5 years. The average time from cancer diagnosis to death was 1.5 years. Among the group of patients who did not develop a post-transplant cancer, 83 patients (16.7%) died, with a median age at time of death of 54.5 years (P < .05). CONCLUSIONS Kidney transplant recipients are at higher risk of developing a post-transplant cancer. Prognosis after cancer diagnosis is poor, probably as a consequence of a more aggressive behavior of cancer in transplant recipients. Intensive screening protocols could allow for an earlier diagnosis thereby improving the long-term outcome of these patients.
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Affiliation(s)
- Rossella Gioco
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Daniela Corona
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesca Privitera
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Alessia Giaquinta
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Ilari Alba
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Sara D'Errico
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Flavia Pinto
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Concetta De Pasquale
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Maria Luisa Pistorio
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy; Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy.
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31
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Summary of the International Conference on Onco-Nephrology: an emerging field in medicine. Kidney Int 2019; 96:555-567. [DOI: 10.1016/j.kint.2019.04.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 01/10/2023]
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Abstract
Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients after cardiovascular disease. Kidney transplant recipients have at least a twofold higher risk of developing or dying from cancer than the general population. The increased risk of de novo and recurrent cancer in transplant recipients is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. Transplant candidates and potential donors should be screened for cancer as part of the assessment process. For potential recipients with a prior history of cancer, waiting periods of 2-5 years after remission - largely depending on the cancer type and stage of initial cancer diagnosis - are recommended. Post-transplantation cancer screening needs to be tailored to the individual patient, considering the cancer risk of the individual, comorbidities, overall prognosis and the screening preferences of the patient. In kidney transplant recipients diagnosed with cancer, treatment includes conventional approaches, such as radiotherapy and chemotherapy, together with consideration of altering immunosuppression. As the benefits of transplantation compared with dialysis in potential transplant candidates with a history of cancer have not been assessed, current clinical practice relies on evidence from observational studies and registry analyses.
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Affiliation(s)
- Eric Au
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
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33
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Wu JH, Qiao PF, Sun XY, Dong JH, Liao JX, Liu XY, Gao Z, Lan LG, Li HB, Su QD. Evaluation and application of donors with primary central nervous system tumors. Clin Transplant 2019; 33:e13677. [PMID: 31342552 DOI: 10.1111/ctr.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to explore the safety of donors with primary central nervous system tumors for kidney and liver transplantations. METHODOLOGY Clinical data of 29 donors with primary CNS tumors in January 2007 to December 2017, as well as the follow-up data of 16 liver transplant recipients and 46 kidney transplant recipients, were analyzed. According to the risk factors, the high-risk group was classified as Group 1, the low-risk factors were classified as Group 2, and the unknown risk group was classified as Group 3. The incidence of donor-transmitted CNS tumors was calculated and compared. RESULTS The duration from the diagnosis of 29 donors to donation was 5.67 ± 6.36 months. None of the liver and kidney transplant recipients who were followed up had tumor metastasis. Although the mean survival time of Group 1 was lower than that of Group 2 and Group 3, the Kaplan-Meier curve showed no significant difference in survival time. CONCLUSION No obvious difference was observed between high-risk and low-risk and unknown risk CNS tumors in terms of the survival rate of transplants and tumor metastasis rate. High-risk CNS tumor donors can be used with the informed consent of recipients after a full evaluation.
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Affiliation(s)
- Ji-Hua Wu
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China.,Organ Transplantation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Peng-Fei Qiao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Xu-Yong Sun
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China.,Organ Transplantation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jian-Hui Dong
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Ji-Xiang Liao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Xu-Yang Liu
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Zhao Gao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Liu-Gen Lan
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Hai-Bin Li
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Qing-Dong Su
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
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34
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How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J Nephrol 2019; 32:323-330. [DOI: 10.1007/s40620-018-00573-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023]
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35
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36
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Abstract
Lung transplantation has become an efficient life-saving treatment for patients with end stage respiratory disease. The increasing good outcome following lung transplantation may be explained by growing experience of transplant teams and availability of potent immunosuppressive drugs. Nevertheless, the latter carries an inherent risk for malignancy besides other common side effects such as systemic hypertension, diabetes and renal dysfunction. Malignancies occur in a smaller proportion of patients but explain for a large proportion of deaths following transplantation. From the first year post-transplantation they will represent the third cause of death with an increasing incidence along post lung transplant survival. In this chapter, we will browse the different types of malignancies arising following lung transplantation. According to the different techniques for lung transplantation, specific types of bronchogenic carcinoma will be described in the explanted lung, in the native lung, and in the graft. Risk factors associated to immunosuppressive therapy, but also to occupational and environmental factors, especially smoking, will be discussed. Eventually, we will strive at integrating recommendations for the treatment of malignancies following lung transplantation.
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Affiliation(s)
- Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
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37
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Xiong J, Su T, Zhu P, Ao Q, Ruan Q, Wang G. Malignant rhabdoid tumor in the renal allograft of an adult transplant recipient: a unique case of a rare tumor. Diagn Pathol 2017; 12:86. [PMID: 29258531 PMCID: PMC5738181 DOI: 10.1186/s13000-017-0677-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Renal transplant recipients have increased risk for developing malignant diseases because of immunosuppression or donor-to-recipient transmission. Malignant rhabdoid tumor (MRT) is a rare, highly aggressive and lethal tumor primarily affecting the kidney of infants and young children. MRT has not been reported in the renal allograft of an adult recipient after kidney transplantation. Case presentation In this report, a 47-year-old woman who received a kidney transplantation from an infant donor and developed a mass in the transplanted kidney is presented. Pathological examinations revealed a malignant tumor with rhabdoid cells morphologically and the loss of INI1 expression immunohistochemically. The diagnosis of malignant rhabdoid tumor in the transplanted kidney was made. We confirmed that donor-to-recipient malignancy transmission was the cause of MRT in the transplanted kidney by fluorescence in situ hybridization (FISH) and short tandem repeat (STR) analysis. Conclusion To our knowledge, this is the first case of MRT in an adult renal allograft recipient. This report highlights the importance of the criteria for selection of donors to screen possible malignant tumors transmission.
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Affiliation(s)
- Jing Xiong
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Tiefen Su
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Pengcheng Zhu
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China. .,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Qilin Ao
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qiurong Ruan
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Guoping Wang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.,Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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Liver Transplantation From Donors With a History of Malignancy: A Single-Center Experience. Transplant Direct 2017; 3:e224. [PMID: 29184912 PMCID: PMC5682768 DOI: 10.1097/txd.0000000000000738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023] Open
Abstract
Background The demand for transplantable organs exceeds donor organ supply. Transplantation of organs from donors with a history of malignancy remains controversial and the transmission of cancer in liver transplant recipients has not been sufficiently examined. Methods From 2002 until 2017, 83 livers from donors with a history of malignancy were transplanted at the University Hospital Essen, Germany. Donor and recipient data, type of malignancy, tumor-free interval at organ procurement, and follow-up data were analyzed. Results Nine different tumor sites (central nervous system [n = 27], genitourinary [n = 24], breast [n = 10], skin [n = 8], colorectal [n = 5], lung [n = 3], hemato-oncological [n = 3], thyroid [n = 2], and larynx [n = 1]) were detected in 83 donors. The majority (58%) of donors had tumor-free intervals of less than 5 years versus 19% of 6 to 10 years versus 23% over 10 years. The risk of tumor transmission from donors was assessed as low in 44 (53%), intermediate in 28 (34%), and high in 11 (13%) cases. During median follow-up of 19.9 (0-155) months, none of the recipients developed donor-transmitted malignancy. Conclusions Liver transplantation with organs from donors with a medical history of malignancy is feasible, and the risk of donor-transmitted malignancy appears to be low in this single-center analysis. A careful selection of donors remains mandatory and can expand the donor pool.
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Eccher A, Cima L, Ciangherotti A, Montin U, Violi P, Carraro A, Tedeschi U, Nacchia F, Fior F, Rostand M, Boschiero L, D'Errico A, Scarpa A, Casartelli-Liviero M, Ferrari G, Rodini V, Tomaselli E, Zampicinini L, Vanzo F, Bovo C, Feltrin G, Neil D, Brunelli M. Rapid screening for malignancy in organ donors: 15-year experience with the Verona “Alert” protocol and review of the literature. Clin Transplant 2017; 31:e13045. [DOI: 10.1111/ctr.13045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Albino Eccher
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Luca Cima
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Andrea Ciangherotti
- Department of Surgical Science; General and Hepatobiliary Surgery; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Montin
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Paola Violi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Amedeo Carraro
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Umberto Tedeschi
- Liver Transplant Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesco Nacchia
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Fior
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Momo Rostand
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Luigino Boschiero
- Department of Surgical Science; Kidney Transplant Center; University and Hospital Trust of Verona; Verona Italy
| | - Antonietta D'Errico
- Pathology Unit; Department of Specialised; Experimental and Diagnostic Medicine; S. Orsola-Malpighi University Hospital of Bologna; Bologna Italy
| | - Aldo Scarpa
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
| | - Marilena Casartelli-Liviero
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Ferrari
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Viviana Rodini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Elisabetta Tomaselli
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Laura Zampicinini
- Neurosurgery and Intensive Care Unit; Department of Surgical Science; University and Hospital Trust of Verona; Verona Italy
| | - Francesca Vanzo
- Arsenàl, Veneto's Research Center for eHealth Innovation; Veneto Italy
| | - Chiara Bovo
- Medical Direction; University and Hospital Trust of Verona; Verona Italy
| | - Giuseppe Feltrin
- Transplant Regional Center; Veneto Region; Hospital Trust of Padova; Padova Italy
| | - Desley Neil
- Pathology Unit; Department of Histopathology; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Matteo Brunelli
- Pathology Unit; Department of Diagnostics and Public Health; University and Hospital Trust of Verona; Verona Italy
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Abstract
The expansion of the donor lung pool has involved an evidence-driven redefinition of acceptable donors. Proceeding with transplantation with an acceptable rather than ideal donor depends on specific patient-related and organ-related risk factors as well as the severity of recipient illness. Although the physiologic optimization of brain-dead donors has not changed significantly in recent years, the use of donor management protocols has improved procurement rates. Ex vivo lung perfusion is an increasingly viable strategy to recondition lungs that would otherwise fall below the acceptable threshold for transplant. Ex vivo perfusion trials for preservation of standard donor lungs are ongoing.
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Affiliation(s)
- Andrew Courtwright
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania School of Medicine, Gates 8, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Edward Cantu
- Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Silverstein Pavilion, Philadelphia, PA 19104-4283, USA.
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Frappaz D, Le Rhun E, Dagain A, Averland B, Bauchet L, Faure A, Guillaume C, Zouaoui S, Provot F, Vachiery F, Taillandier L, Hoang-Xuan K. [Recommendations for the organ donation from patients with brain or medullary primitive tumors on behalf of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery]. Bull Cancer 2017; 104:771-788. [PMID: 28549594 DOI: 10.1016/j.bulcan.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/18/2022]
Abstract
Requests of organs to be transplanted increase. As a matter of urgency, it is not always easy to decide if a patient carrier of a brain tumor can be candidate in the donation. After a review of the literature, the members of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery propose consensual recommendations in case of donor carrier of primitive tumor intra-cranial or intra-medullary. A contact with the neuro-oncologist/neurosurgeon will allow to discuss the indication in case of glioma of grade I/II/III, according to the grade, the current status (absence of progressive disease), the number of surgeries and of lines of treatment. The taking is disadvised in case of glioma of grade IV (glioblastoma), of lymphoma or meningioma of grade III. No contraindication for the meningiomas of grade I, and individual discussion for the meningiomas of grade II. It is advisable to remain careful in case of hemangiopericytoma and of meningeal solitary fibrous tumor. The patients in first complete remission of a medulloblastoma or intra-cranial primitive germinoma seem good candidates for the taking of organ if the follow-up is of at least 10 years (3 years for non germinomas). In every case, a multidisciplinary discussion is desirable when it is materially possible.
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Affiliation(s)
- Didier Frappaz
- Centre Léon-Bérard, 28, rue Laennec, 69673 Lyon, France.
| | - Emilie Le Rhun
- University hospital, department of neurosurgery, neuro-oncology, 59037 Lille, France; Oscar-Lambret center, department of medical oncology, Breast unit, 59037 Lille, France; Lille university, Inserm U-1192, laboratoire de protéomique, réponse inflammatoire, spectrométrie de masse (PRISM), 59037 Lille, France
| | - Arnaud Dagain
- HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - Benoît Averland
- Agence de la biomédecine, 1, avenue du Stade de France, 93210 Saint-Denis, France
| | - Luc Bauchet
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | | | | | - Sonia Zouaoui
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | | | - Florence Vachiery
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - Luc Taillandier
- CHU de Nancy, 5, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Khê Hoang-Xuan
- APHP, UMPC-Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
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Baudoux TER, Gastaldello K, Rorive S, Hamade A, Broeders N, Nortier JL. Donor Cancer Transmission in Kidney Transplantation. Kidney Int Rep 2016; 2:134-137. [PMID: 29318211 PMCID: PMC5720622 DOI: 10.1016/j.ekir.2016.09.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Thomas E R Baudoux
- Nephrology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Karine Gastaldello
- Nephrology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Rorive
- Pathology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Anwar Hamade
- Nephrology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nilufer Broeders
- Nephrology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joëlle L Nortier
- Nephrology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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44
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Friberg S, Nyström A. Cancer Metastases: Early Dissemination and Late Recurrences. CANCER GROWTH AND METASTASIS 2015; 8:43-9. [PMID: 26640389 PMCID: PMC4664198 DOI: 10.4137/cgm.s31244] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Metastatic cells from a primary tumor can occur before the primary cancer is detected. Metastatic cells can also remain in the patient for many years after removal of the primary tumor without proliferating. These dormant malignant cells can awaken and cause recurrent disease decades after the primary treatment. The purpose of this article is to review the clinical evidence for early dissemination and late recurrences in human malignant tumors. We used the following definitions: dormancy of cells may be defined as a nonproliferating state or an arrest in the cell cycle that results in a prolonged G0 phase. If one accepts the term "late metastases" to indicate a period exceeding 10 years from the removal of the primary tumor, then the two malignancies in which this occurs most frequently are cutaneous malignant melanoma (CMM) and renal cell carcinoma (RCC). METHODS PubMed, Web of Science, and Scopus were searched with the keywords "metastases," "early dissemination," "late recurrences," "inadvertently transmitted cancer," "tumor growth rate," "dormancy," "circulating tumor cells," and "transplantation of cancer." RESULTS Several case reports of early dissemination and late recurrences of various types of malignancies were found. Analyses of the growth rates of several malignant tumors in the original host indicated that the majority of cancers had metastasized years before they were detected. CMM, RCC, and malignant glioblastoma were the three most common malignancies resulting from an organ transplantation. CMM and RCC were also the two most common malignancies that showed dormancy. In several cases of transplanted CMM and RCC, the donor did not have any known malignancy or had had the malignancy removed so long ago that the donor was regarded as cured. CONCLUSION (1) Metastases can frequently exist prior to the detection of the primary tumor. (2) Metastatic cells may reside in organs in the original host that are not usually the site of detectable secondary tumors, for example, the kidneys and heart. (3) Metastatic cells remain dormant for decades after the primary tumor has been removed. (4) Dormancy might be reversible and lead to late recurrences.
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Affiliation(s)
- Sten Friberg
- Swedish Medical Nanoscience Centre, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Nyström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Pandanaboyana S, Longbotham D, Hostert L, Attia M, Baker R, Menon K, Ahmad N. Transplantation of liver and kidney from donors with malignancy at the time of donation: an experience from a single centre. Transpl Int 2015; 29:73-80. [DOI: 10.1111/tri.12693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/12/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sanjay Pandanaboyana
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
- Department of Surgery; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - David Longbotham
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
| | - Lutz Hostert
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
| | - Magdy Attia
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
| | - Richard Baker
- Department of Nephrology; St James's University Hospital; Leeds UK
| | - Krishna Menon
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
| | - Niaz Ahmad
- Division of Surgery; Department of Transplantation; St James's University Hospital; Leeds UK
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46
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Giessing M. [Urological follow-up and development of cancer after renal transplantation]. Urologe A 2015; 54:1393-401. [PMID: 26459582 DOI: 10.1007/s00120-015-3910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The number of renal transplant recipients is rising, as well as graft and recipient survival. The mainstay of urological follow-up is to ensure urine transport and voiding function; also, the diagnosis and treatment of urological malignancies following renal transplantats is growing in importance. As urological malignancies are one of the three most common tumors following renal transplantation (RT), meticulous and regular urological evaluation is a central part of follow-up care after RT. RECOMMENDATIONS Urological evaluation following RT must ensure correct urine transport and voiding function. Transplant ureter strictures, relevant ureteral reflux and voiding dysfuntion (e.g., neurologic dysfunction, benign prostate hypeplasia) must be excluded or treated. Urinary tract infection (UTI), which can be life threatening in the immunosuppressed transplant recipient, must be diagnosed and treated consequently and for an adequate period of time. Prophylaxis of UTIs is indicated in patients with recurrent symptomatic UTI as well as in the initial 6 months following renal transplantation. Asymptomatic bacteriuria must not necessarily be treated. The incidence of urological malignancies like renal cell carcinoma, urothelial cancer of the bladder, and penile carcinoma is increased following RT, while the incidence of prostate and testis cancer is the same as in the nontransplant population. Surgical and nonsurgical treatment options do not differ from the normal population. Adaptation, cessation, or switching of the immunosuppressive regimen in case of urologic malignancy must be decided on the individual recipient basis.
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Affiliation(s)
- M Giessing
- Universitätsklinik für Urologie, Heinrich Heine-Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
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Lugo-Baruqui JA, Guerra G, Chen L, Burke GW, Gaite JA, Ciancio G. Living donor renal transplantation with incidental renal cell carcinoma from donor allograft. Transpl Int 2015; 28:1126-30. [DOI: 10.1111/tri.12594] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/02/2015] [Accepted: 04/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jose A. Lugo-Baruqui
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
- Department of Surgery; University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital; Miami FL USA
| | - Giselle Guerra
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
- Department of Medicine; Division of Nephrology of the University of Miami Miller School of Medicine; Miami FL USA
| | - Linda Chen
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
- Department of Surgery; University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital; Miami FL USA
| | - George W. Burke
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
- Department of Surgery; University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital; Miami FL USA
| | - Judith A. Gaite
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
| | - Gaetano Ciancio
- The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation; Miami FL USA
- Department of Surgery; University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital; Miami FL USA
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Lowe D, Daga S, Briggs D, Khovanova N, Mitchell D, Higgins R, Krishnan N. Meeting report: 3rd international transplant conference: how much risk can you take? Int J Immunogenet 2015; 42:59-68. [PMID: 25684274 DOI: 10.1111/iji.12184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/09/2015] [Accepted: 01/27/2015] [Indexed: 01/08/2023]
Abstract
The 3rd International Transplant Conference took place on 31st October and 1st November 2014 at the University of Warwick, Coventry, UK. Key focal points of the meeting were the exploration of the molecular basis of antibody-antigen interactions and their relation to clinical practice and to share experiences and knowledge regarding strategies to transplant the 'high-risk' patient. In addition, lively debate sessions were hosted where controversial clinical and immunological themes were discussed by leading experts in the field.
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Affiliation(s)
- D Lowe
- Transplant Immunology, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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50
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Salvadori M, Bertoni E. What's new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4:243-66. [PMID: 25540734 PMCID: PMC4274595 DOI: 10.5500/wjt.v4.i4.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/11/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023] Open
Abstract
Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ito III of clinical studies and trials.
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