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Malvi D, Vasuri F, Albertini E, Carbone M, Novelli L, Mescoli C, Cardillo M, Pagni F, D'Errico A, Eccher A. Donors risk assessment in transplantation: From the guidelines to their real-world application. Pathol Res Pract 2024; 255:155210. [PMID: 38422913 DOI: 10.1016/j.prp.2024.155210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Transplantation of an organ from a donor carries an unavoidable risk of tumor transmission. The need to extend the donor pool increases the use of organs from donors with malignancies and potential disease transmission is a constant tension influencing donor suitability decisions. Current classification systems for the assessment of donor malignancy transmission risk have evolved from reports of potential transmission events in recipients to national donation and transplant surveillance agencies. Although the risk of malignancy transmission is very low in the general transplant setting it must constantly be balanced with the transplant benefits. Guidelines are mainly based on large registries and sparse case reports of transmission, so they cannot cover all the possible situations. For this reason, in 2004 in Italy, the National Transplant Center gave rise to the Second Opinion Service, charged by the Ministry of Health, by structuring expertise in diagnostic oncology and risk transmission and making it available to the Italian Transplant Centers. In this paper the registry of the Italian Oncological Second Opinion was reviewed, from 2016 to 2018, to detail the most frequent and problematic neoplastic topics addressed, those are separately reported and discussed. Furthermore, a review of the most recent strategies and risk stratification is provided, according to the most recent literature evidence and to the European Guidelines.
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Affiliation(s)
- Deborah Malvi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elisa Albertini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maurizio Carbone
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, Italy
| | - Massimo Cardillo
- Italian National Transplantation Center, Italian National Institute of Health, Rome, Italy
| | - Fabio Pagni
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Antonia D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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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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3
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Hedley JA, Kelly PJ, Wyld M, Shah K, Morton RL, Byrnes J, Rosales BM, De La Mata NL, Wyburn K, Webster AC. Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting. Transplant Direct 2023; 9:e1474. [PMID: 37090124 PMCID: PMC10118354 DOI: 10.1097/txd.0000000000001474] [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: 09/11/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 04/25/2023] Open
Abstract
Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors' medical history and their absolute transmission risk or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare, and prolonging waiting time for recipients is harmful. Methods We assessed the cost-effectiveness of increasing utilization of potential deceased donors with brain cancer using a Markov model simulation of 1500 patients waitlisted for a kidney transplant, based on linked transplant registry data and with a payer perspective (Australian government). We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk, improved cancer classification accuracy with real-time data-linkage to hospital records and cancer registries, and increased risk tolerance to allow intermediate-risk donors (up to 6.4% potential transmission risk). Results Compared with current practice, decision support provided 0.3% more donors with an average transmission risk of 2%. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk). Interventions were dominant (improved QALYs and saved costs) in 78%, 80%, and 87% of simulations, respectively. The largest benefit was from increasing risk tolerance (mean +18.6 QALYs and AU$2.2 million [US$1.6 million] cost-savings). Conclusions Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.
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Affiliation(s)
- James A. Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Patrick J. Kelly
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - Karan Shah
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Juliet Byrnes
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Brenda M. Rosales
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nicole L. De La Mata
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Wyburn
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Renal Unit, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Angela C. Webster
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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4
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Greenhall GHB, Rous BA, Robb ML, Brown C, Hardman G, Hilton RM, Neuberger JM, Dark JH, Johnson RJ, Forsythe JLR, Tomlinson LA, Callaghan CJ, Watson CJE. Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission. JAMA Surg 2023; 158:504-513. [PMID: 36947028 PMCID: PMC10034666 DOI: 10.1001/jamasurg.2022.8419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Cancer transmission is a known risk for recipients of organ transplants. Many people wait a long time for a suitable transplant; some never receive one. Although patients with brain tumors may donate their organs, opinions vary on the risks involved. Objective To determine the risk of cancer transmission associated with organ transplants from deceased donors with primary brain tumors. Key secondary objectives were to investigate the association that donor brain tumors have with organ usage and posttransplant survival. Design, Setting, and Participants This was a cohort study in England and Scotland, conducted from January 1, 2000, to December 31, 2016, with follow-up to December 31, 2020. This study used linked data on deceased donors and solid organ transplant recipients with valid national patient identifier numbers from the UK Transplant Registry, the National Cancer Registration and Analysis Service (England), and the Scottish Cancer Registry. For secondary analyses, comparators were matched on factors that may influence the likelihood of organ usage or transplant failure. Statistical analysis of study data took place from October 1, 2021, to May 31, 2022. Exposures A history of primary brain tumor in the organ donor, identified from all 3 data sources using disease codes. Main Outcomes and Measures Transmission of brain tumor from the organ donor into the transplant recipient. Secondary outcomes were organ utilization (ie, transplant of an offered organ) and survival of kidney, liver, heart, and lung transplants and their recipients. Key covariates in donors with brain tumors were tumor grade and treatment history. Results This study included a total of 282 donors (median [IQR] age, 42 [33-54] years; 154 females [55%]) with primary brain tumors and 887 transplants from them, 778 (88%) of which were analyzed for the primary outcome. There were 262 transplants from donors with high-grade tumors and 494 from donors with prior neurosurgical intervention or radiotherapy. Median (IQR) recipient age was 48 (35-58) years, and 476 (61%) were male. Among 83 posttransplant malignancies (excluding NMSC) that occurred over a median (IQR) of 6 (3-9) years in 79 recipients of transplants from donors with brain tumors, none were of a histological type matching the donor brain tumor. Transplant survival was equivalent to that of matched controls. Kidney, liver, and lung utilization were lower in donors with high-grade brain tumors compared with matched controls. Conclusions and Relevance Results of this cohort study suggest that the risk of cancer transmission in transplants from deceased donors with primary brain tumors was lower than previously thought, even in the context of donors that are considered as higher risk. Long-term transplant outcomes are favorable. These results suggest that it may be possible to safely expand organ usage from this donor group.
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Affiliation(s)
- George H B Greenhall
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
- School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Brian A Rous
- National Cancer Registration and Analysis Service, Fulbourn, United Kingdom
| | - Matthew L Robb
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Chloe Brown
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Gillian Hardman
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Rachel M Hilton
- Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom
| | - James M Neuberger
- Liver Unit, Queen Elizabeth Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Rachel J Johnson
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - John L R Forsythe
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Laurie A Tomlinson
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris J Callaghan
- School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom
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5
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Thomson IK, Hedley J, Rosales BM, Wyburn K, O'Leary MJ, Webster AC. Potential organ donors with primary brain tumours: missed opportunities for donation and transplantation identified in Australian cohort study 2010-2015. ANZ J Surg 2022; 92:2996-3003. [PMID: 36129448 PMCID: PMC9826272 DOI: 10.1111/ans.18037] [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: 04/16/2022] [Revised: 07/03/2022] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Potential organ donors with primary brain tumours (PBT) frequently donate, however some may be declined due to uncertainty about tumour classification or transmission risk to transplant recipients. We sought to describe transmission risk and donation outcome of potential donors with PBT, including identifying missed opportunities for transplantation, and any PBT transmission events. METHODS We undertook a population-based cohort study in NSW of all potential donors 2010-2015. PBT potential donors were characterized according to tumour grade and transmission risk, and whether they donated organs. Data linkage was used to determine agreement of risk assessment of potential donors to that in the Biovigilance Register, and to identify any PBT transmissions. RESULTS Of 2957 potential donors, 76 (3%) had PBTs. There was agreement of risk assessment in 44 (58%) cases. PBT potential donors had fewer comorbidities (1.6 vs. 2.1, P = 0.006) than non-PBT potential donors. Forty-eight (63%) potential donors were declined for non-PBT reasons, 18 (24%) were declined because of perceived PBT transmission risk and 10 (13%) donated. All PBT donors had WHO-I or -II tumours, and none had a ventriculo-pertioneal shunt. No transmission events occurred. CONCLUSION Donors with WHO-I/II PBT appear to have minimal risk of tumour transmission in solid organ transplantation; it is reassuring that no PBT transmission occurred. There is evidence of risk aversion to referrals with WHO-III/IV tumours. There exists opportunity to improve potential donor risk assessment at the time of referral using integrated data sets, and to increase organ donation and transplantation rates through greater utilization of PBT referrals.
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Affiliation(s)
- Imogen K. Thomson
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - James Hedley
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Brenda M. Rosales
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kate Wyburn
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia,Renal DepartmentRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Michael J. O'Leary
- Intensive Care UnitRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia,New South Wales Organ and Tissue Donation ServiceKogarahNew South WalesAustralia
| | - Angela C. Webster
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia,Centre for Transplant and Renal ResearchWestmead HospitalWestmeadNew South WalesAustralia
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Ammendola S, Barresi V, Bariani E, Girolami I, D’Errico A, Brunelli M, Cardillo M, Lombardini L, Carraro A, Boggi U, Cain O, Neil D, Eccher A. Risk factors of extraneural spreading in astrocytomas and oligodendrogliomas in donors with gliomas: A systematic review. World J Transplant 2022; 12:131-141. [PMID: 35979537 PMCID: PMC9258267 DOI: 10.5500/wjt.v12.i6.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with a history of primary brain tumors can be eligible for organ donation under extended criteria. The risk assessment of tumor transmission via organ transplant in primary brain tumors is primarily based on the assessment of tumor histotype and grade. Previous surgeries, chemo-/radiotherapy, and ventriculo-peritoneal shunt placement can lead to a disruption of the blood-brain barrier, concurring to an increase in the transmission risk.
AIM To investigate the role of tumor transmission risk factors in donors with oligodendrogliomas and astrocytomas.
METHODS We searched PubMed and EMBASE databases for studies reporting extraneural spreading of oligodendrogliomas and astrocytomas and extracted clinical-pathological data on the primary tumor histotype and grade, the elapsed time from the diagnosis to the onset of metastases, sites and number of metastases, prior surgeries, prior radiotherapy and/or chemotherapy, ventriculo-atrial or ventriculo-peritoneal shunt placement, and the presence of isocitrate dehydrogenase 1/2 mutation and 1p/19q codeletion. Statistical analysis was performed using R software. Statistical correlation between chemotherapy or radiotherapy and the presence of multiple extra-central nervous system metastases was analyzed using χ2 and Fischer exact test. The Kaplan-Meier method was used to evaluate the presence of a correlation between the metastasis-free time and: (1) Localization of metastases; (2) The occurrence of intracranial recurrences; and (3) The occurrence of multiple metastases.
RESULTS Data on a total of 157 patients were retrieved. The time from the initial diagnosis to metastatic spread ranged from 0 to 325 mo in patients with oligodendrogliomas and 0 to 267 mo in those with astrocytomas. Respectively, 19% and 39% of patients with oligodendroglioma and astrocytoma did not receive any adjuvant therapy. The most frequent metastatic sites were bone, bone marrow, and lymph nodes. The lungs and the liver were the most commonly involved visceral sites. There was no significant correlation between the occurrence of multiple metastases and the administration of adjuvant chemo-/radiotherapy. Patients who developed intracranial recurrences/metastases had a significantly longer extraneural metastasis-free time compared to those who developed extraneural metastases in the absence of any intra- central nervous system spread.
CONCLUSION A long follow-up time does not exclude the presence of extraneural metastases. Therefore, targeted imaging of bones and cervical lymph nodes may improve safety in the management of these donors.
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Affiliation(s)
- Serena Ammendola
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Valeria Barresi
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Elena Bariani
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital, Bolzano 39100, Italy
| | - Antonia D’Errico
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna 40138, Italy
| | - Matteo Brunelli
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Massimo Cardillo
- National Transplant Center, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Letizia Lombardini
- National Transplant Center, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Amedeo Carraro
- General Surgery and Liver Transplant Unit, Verona University Hospital, Verona 37126, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa 56126, Italy
| | - Owen Cain
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Desley Neil
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Albino Eccher
- Department of Pathology and Diagnostics, Verona University Hospital, Verona 37126, Italy
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7
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Donor Cancer Transmission: Focusing on the Evidence. Transplantation 2022; 106:1728-1729. [DOI: 10.1097/tp.0000000000004118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors. Transplant Direct 2022; 8:e1252. [PMID: 35047659 PMCID: PMC8759621 DOI: 10.1097/txd.0000000000001252] [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: 07/13/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. There is an imperative to maximize donation opportunities given ongoing organ shortages, but donor suitability assessments can be challenging. Methods. We analyzed an Australian cohort of potential deceased donors 2010 to 2013 to explore misclassification of cancer risk and potential strategies for improvement (decision support, real-time data linkage to existing data sets, and increasing risk tolerance). Cancer history perceived at referral was compared with verified cancer history in linked health records. Transmission risks were based on clinical guidelines. Potential donors declined due to cancer but verified low risk were missed opportunities; those accepted but verified high risk were excess-risk donors. Results. Among 472 potentially suitable donor referrals, 132 (28%) were declined because of perceived transmission risk and 340 (72%) donated. Assuming a low-risk threshold, there were 38/132 (29%) missed opportunities and 5/340 (1%) excess-risk donors. With decision support, there would have been 5 (13%) fewer missed opportunities and 2 (40%) more excess-risk donors; with real-time data linkage, 6 (16%) fewer missed opportunities and 2 (40%) fewer excess-risk donors; and with increased risk tolerance, 6 (16%) fewer missed opportunities and 11 (220%) more excess-risk donors. Conclusions. Potential donors’ cancer history is typically incomplete at referral. There are missed opportunities where decision support or more accurate cancer history could safely increase organ donors.
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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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10
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Hedley JA, Vajdic CM, Wyld M, Waller KMJ, Kelly PJ, De La Mata NL, Rosales BM, Wyburn K, Webster AC. Cancer transmissions and non-transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors. Transpl Int 2021; 34:1667-1679. [PMID: 34448264 DOI: 10.1111/tri.13989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/21/2023]
Abstract
Evidence on cancer transmission from organ transplantation is poor. We sought to identify cases of cancer transmission or non-transmission from transplantation in an Australian cohort of donors and recipients. We included NSW solid organ deceased donors 2000-2012 and living donors 2004-2012 in a retrospective cohort using linked data from the NSW Biovigilance Register (SAFEBOD). Central Cancer Registry (CCR) data 1972-2013 provided a minimum one-year post-transplant follow-up. We identified cancers in donors and recipients. For each donor-recipient pair, the transmission was judged likely, possible, unlikely, or excluded using categorization from international guidelines. In our analysis, transmissions included those judged likely, while those judged possible, unlikely, or excluded were non-transmissions. In our cohort, there were 2502 recipients and 1431 donors (715 deceased, 716 living). There were 2544 transplant procedures, including 1828 (72%) deceased and 716 (28%) living donor transplants. Among 1431 donors, 38 (3%) had past or current cancer and they donated to 68 recipients (median 6.7-year follow-up). There were 64 (94%) non-transmissions, and 4 (6%) transmissions from two living and two deceased donors (all kidney cancers discovered during organ recovery). Donor transmitted cancers are rare, and selected donors with a past or current cancer may be safe for transplantation.
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Affiliation(s)
- James A Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Claire M Vajdic
- Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Karen M J Waller
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Patrick J Kelly
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Nicole L De La Mata
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Brenda M Rosales
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Kate Wyburn
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Angela C Webster
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.,National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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11
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Gingras MC, Sabo A, Cardenas M, Rana A, Dhingra S, Meng Q, Hu J, Muzny DM, Doddapaneni H, Perez L, Korchina V, Nessner C, Liu X, Chao H, Goss J, Gibbs RA. Sequencing of a central nervous system tumor demonstrates cancer transmission in an organ transplant. Life Sci Alliance 2021; 4:4/9/e202000941. [PMID: 34301805 PMCID: PMC8321656 DOI: 10.26508/lsa.202000941] [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: 10/20/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
This study uses DNA sequencing to trace a donor organ transplant–mediated cancer transmission and illustrates how precise molecular pathology profiles might reduce future risk for transplant recipients. Four organ transplant recipients from an organ donor diagnosed with anaplastic pleomorphic xanthoastrocytoma developed fatal malignancies for which the origin could not be confirmed by standard methods. We identified the somatic mutational profiles of the neoplasms using next-generation sequencing technologies and tracked the relationship between the different samples. The data were consistent with the presence of an aggressive clonal entity in the donor and the subsequent proliferation of descendent tumors in each recipient. Deleterious mutations in BRAF, PIK3CA, SDHC, DDR2, and FANCD2, and a chromosomal deletion spanning the CDKN2A/B genes, were shared between the recipients’ lesions. In addition to demonstrating that DNA sequencing tracked a donor/recipient cancer transmission, this study established that the genetic profile of a donor tumor and its potential aggressive phenotype could have been determined before transplantation was considered. As the genetic correlates of tumor invasion and metastases become better known, adding genetic profiling by DNA sequencing to the data considered for transplant safety should be considered.
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Affiliation(s)
- Marie-Claude Gingras
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA .,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aniko Sabo
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Maria Cardenas
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Abbas Rana
- Abdominal Transplant Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sadhna Dhingra
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Qingchang Meng
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jianhong Hu
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Harshavardhan Doddapaneni
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lesette Perez
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Viktoriya Korchina
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Caitlin Nessner
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Xiuping Liu
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Hsu Chao
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - John Goss
- Abdominal Transplant Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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12
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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: 22] [Impact Index Per Article: 7.3] [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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13
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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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14
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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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15
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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: 30] [Impact Index Per Article: 7.5] [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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16
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Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010-2015. Transplant Direct 2019; 5:e504. [PMID: 31773057 PMCID: PMC6831119 DOI: 10.1097/txd.0000000000000938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/25/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022] Open
Abstract
Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.
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17
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18
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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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19
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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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20
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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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21
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Huang S, Tang Y, Zhu Z, Yang J, Zhang Z, Wang L, Sun C, Zhang Y, Zhao Q, Chen M, Wu L, Wang D, Ju W, Guo Z, He X. Outcomes of Organ Transplantation from Donors with a Cancer History. Med Sci Monit 2018; 24:997-1007. [PMID: 29455213 PMCID: PMC5825978 DOI: 10.12659/msm.909059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The inherent challenges of selecting an acceptable donor for the increasing number and acuity of recipients has forced programs to take increased risks, including accepting donors with a cancer history (DWCH). Outcomes of organ transplantation using organs from DWCH must be clarified. We assessed transplant outcomes of recipients of organs from DWCH. Material/Methods Retrospective analysis of the Scientific Registry of Transplant Recipients data from January 1, 2000 to December 31, 2014 identified 8385 cases of transplants from DWCH. A Cox-proportional hazard regression model and log-rank test were used to compare patient survival and hazard levels of various cancer types. Results DWCH was an independent risk factor of 5-year patient survival (HR=1.089, 95% CI: 1.009–1.176, P=0.03) and graft survival (HR=1.129, 95% CI: 1.056–1.208, P<0.01) in liver and heart transplantation (patient survival: HR=1.112, 95% CI: 1.057–1.170, P<0.01; graft survival: HR=1.244, 95% CI: 1.052–1.472, P=0.01). There was no remarkable difference between the 2 groups in kidney and lung transplantation. Donors with genitourinary and gastrointestinal cancers were associated with inferior outcomes in kidney transplantation. Transplantation from donors with central nervous system cancer resulted in poorer survival in liver transplant recipients. Recipients of organs from donors with hematologic malignancy and otorhinolaryngologic cancer had poorer survival following heart transplantation. Conclusions Under the current donor selection criteria, recipients of organs from DWCH had inferior outcomes in liver and heart transplantation, whereas organs from DWCH were safely applied in kidney and lung transplantation. Specific cancer types should be cautiously evaluated before performing certain types of organ transplantation.
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Affiliation(s)
- Shanzhou Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Yunhua Tang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Zebin Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Jie Yang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Zhiheng Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Linhe Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Chengjun Sun
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Yixi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Qiang Zhao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Maogen Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Linwei Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).,Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, Guangdong, China (mainland)
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22
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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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23
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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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24
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Westphal GA, Garcia VD, de Souza RL, Franke CA, Vieira KD, Birckholz VRZ, Machado MC, de Almeida ERB, Machado FO, Sardinha LADC, Wanzuita R, Silvado CES, Costa G, Braatz V, Caldeira Filho M, Furtado R, Tannous LA, de Albuquerque AGN, Abdala E, Gonçalves ARR, Pacheco-Moreira LF, Dias FS, Fernandes R, Giovanni FD, de Carvalho FB, Fiorelli A, Teixeira C, Feijó C, Camargo SM, de Oliveira NE, David AI, Prinz RAD, Herranz LB, de Andrade J. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva 2017; 28:220-255. [PMID: 27737418 PMCID: PMC5051181 DOI: 10.5935/0103-507x.20160049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
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Affiliation(s)
- Glauco Adrieno Westphal
- Corresponding author: Glauco Adrieno Westphal, Centro
Hospitalar Unimed, Rua Orestes Guimarães, 905, Zip code: 89204-060 -
Joinville (SC), Brazil. E-mail:
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25
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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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26
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Kumar S, Modi PR, Pal BC, Modi J. Can deceased donor with recurrent primary brain tumor donate kidneys for transplantation? Indian J Urol 2016; 32:74-6. [PMID: 26941500 PMCID: PMC4756557 DOI: 10.4103/0970-1591.173104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kidney transplantation from deceased donors is in its infancy in India. Cadaver organ donation was accepted legally in 1994 by the "Human Organs Transplantation Act." Marginal donors are now accepted by many centers for kidney transplantation. We report a case of procurement of both kidneys from a young deceased donor having recurrent primary brain tumor, transplanted into two adult recipients with successful outcome.
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Affiliation(s)
- Suresh Kumar
- Department of Urology, Institute of Kidney Disease and Research Centre, Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pranjal R Modi
- Department of Urology, Institute of Kidney Disease and Research Centre, Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, India
| | - Bipin C Pal
- Department of Urology, Institute of Kidney Disease and Research Centre, Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, India
| | - Jayesh Modi
- Department of Urology, Institute of Kidney Disease and Research Centre, Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, India
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27
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Abstract
Glioblastoma is the most common and aggressive primary brain tumor in adults. Defining histopathologic features are necrosis and endothelial proliferation, resulting in the assignment of grade IV, the highest grade in the World Health Organization (WHO) classification of brain tumors. The classic clinical term "secondary glioblastoma" refers to a minority of glioblastomas that evolve from previously diagnosed WHO grade II or grade III gliomas. Specific point mutations of the genes encoding isocitrate dehydrogenase (IDH) 1 or 2 appear to define molecularly these tumors that are associated with younger age and more favorable outcome; the vast majority of glioblastomas are IDH wild-type. Typical molecular changes in glioblastoma include mutations in genes regulating receptor tyrosine kinase (RTK)/rat sarcoma (RAS)/phosphoinositide 3-kinase (PI3K), p53, and retinoblastoma protein (RB) signaling. Standard treatment of glioblastoma includes surgery, radiotherapy, and alkylating chemotherapy. Promoter methylation of the gene encoding the DNA repair protein, O(6)-methylguanyl DNA methyltransferase (MGMT), predicts benefit from alkylating chemotherapy with temozolomide and guides choice of first-line treatment in elderly patients. Current developments focus on targeting the molecular characteristics that drive the malignant phenotype, including altered signal transduction and angiogenesis, and more recently, various approaches of immunotherapy.
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28
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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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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2013.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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30
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Dyson M, Watson CJ, Liddell K, Padfield N, Bradley JA, Saeb-Parsy K. Transplanting suboptimum organs: medico-legal implications. Lancet 2015; 386:719-21. [PMID: 26333958 DOI: 10.1016/s0140-6736(15)61413-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Dyson
- Faculty of Law, University of Cambridge, Cambridge, UK; Trinity College, University of Cambridge, Cambridge, UK
| | - Christopher J Watson
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Kathleen Liddell
- Faculty of Law, University of Cambridge, Cambridge, UK; Centre for Law, Medicine and Life Sciences, University of Cambridge, Cambridge, UK
| | | | - J Andrew Bradley
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
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31
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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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33
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Organ transplantation from donors (cadaveric or living) with a history of malignancy: Review of the literature. Transplant Rev (Orlando) 2014; 28:169-75. [DOI: 10.1016/j.trre.2014.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/15/2014] [Accepted: 06/11/2014] [Indexed: 12/11/2022]
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34
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Desai R, Collett D, Watson CJE, Johnson P, Evans T, Neuberger J. Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry. Br J Surg 2014; 101:768-74. [PMID: 24771410 DOI: 10.1002/bjs.9460] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transplanted organs carry the risk of inadvertent donor cancer transmission. Some cancers in organ donors have been classified as being associated with a high or unacceptable risk, but the evidence for such recommendations is scanty. METHODS The risk of cancer transmission from donors characterized as high or unacceptable risk was studied by analysing transplant and cancer registry data. Donors and recipients from England (1990-2008) were identified from the UK Transplant Registry. Cancer details were obtained from cancer registries and classified using guidelines from the Council of Europe and Organ Procurement and Transplantation Network/United Network for Organ Sharing. RESULTS Of 17,639 donors, 202 (1.1 per cent) had a history of cancer, including 61 donors with cancers classed as having an unacceptable/high risk of transmission. No cancer transmission was noted in 133 recipients of organs from these 61 donors. At 10 years after transplantation, the additional survival benefit gained by transplanting organs from donors with unacceptable/high-risk cancer was 944 (95 per cent confidence interval (c.i.) 851 to 1037) life-years, with a mean survival of 7.1 (95 per cent c.i. 6.4 to 7.8) years per recipient. CONCLUSION Strict implementation of present guidelines is likely to result in overestimation of cancer transmission risk in some donors. Organs from some donors with cancers defined as unacceptable/high risk can be used safely.
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Affiliation(s)
- R Desai
- NHS Blood and Transplant, Bristol, UK
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35
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Magiorkinis G, Belshaw R, Katzourakis A. 'There and back again': revisiting the pathophysiological roles of human endogenous retroviruses in the post-genomic era. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120504. [PMID: 23938753 PMCID: PMC3758188 DOI: 10.1098/rstb.2012.0504] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Almost 8% of the human genome comprises endogenous retroviruses (ERVs). While they have been shown to cause specific pathologies in animals, such as cancer, their association with disease in humans remains controversial. The limited evidence is partly due to the physical and bioethical restrictions surrounding the study of transposons in humans, coupled with the major experimental and bioinformatics challenges surrounding the association of ERVs with disease in general. Two biotechnological landmarks of the past decade provide us with unprecedented research artillery: (i) the ultra-fine sequencing of the human genome and (ii) the emergence of high-throughput sequencing technologies. Here, we critically assemble research about potential pathologies of ERVs in humans. We argue that the time is right to revisit the long-standing questions of human ERV pathogenesis within a robust and carefully structured framework that makes full use of genomic sequence data. We also pose two thought-provoking research questions on potential pathophysiological roles of ERVs with respect to immune escape and regulation.
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