Status:
Ready to upload
Record number:
2153
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
For donor cancer transmission risk estimates please refer to the most recent edition of Council of Europe "Guide to the quality and safety of organs for transplantation".
In this registry analysis, 349 of 10 076 (3.5%) utilized organ donors were found to have a malignancy. In 275 cases, donor cancer was known prior to transplant (168 with history of cancer and 107 diagnosed at time of donation). No tumor transmissions occurred in this subgroup who donated organs to 651 recipients.
An additional 74 donors had a diagnosis of malignancy after transplantation and donated organs to a total of 151 recipients. 10 donors in this group transmitted cancer to 16 of 25 recipients and the remaining 64 donors did not transmit cancer to 126 recipients.
Of 802 recipients at risk, therefore, 16 (2%) developed cancer. During this time, 26,483 organs were transplanted into 25,785 recipients, corresponding to 6.2 cases of donor transmitted cancer per 10,000 solid organ transplants. This is in line with previous estimates.
Time to detection:
Tumors were transmitted by 10 (of 74) donors who had malignancies that were not discovered until after donation. These 10 donors transmitted tumors to 16 of 25 recipients. Transmissions were diagnosed at a median of 14 months (range 0.3-49 months, interquartile range 11-24 months).
Alerting signals, symptoms, evidence of occurrence:
Lung cancer transmitted to 9 recipients (4 small cell, 5 non-small cell): Graft dysfunction in 5 (@7-44 months); incidental on scan or biopsy in 2 (@5-6 months); diagnosed on studies following notification of tumor in recipient from same donor in 2 (6 months).
Renal cell carcinoma transmitted to 2 recipients: incidental on graft explant for dysfunction in 1 (@1 month); incidental to biopsy for graft dysfunction in 1 (@5months)
Cholangiocarcinoma transmitted to 1 recipient: incidental on liver transplant explantation @47 months.
Duodenal cancer transmitted to 2 recipients: ascites with peritoneal carcinomatosis in 1 recipient @25 months; cutaneous lesions in 1 recipient @25 months.
Prostate cancer transmitted to 1 recipient: incidental on routine graft ultrasound @5 months.
Undifferentiated cancer transmitted to 1 recipient: incidental on protocol graft ultrasound @0.3 months.
Demonstration of imputability or root cause:
The classification system of UNOS DTAC was used to categorize the 16 tumors. 12 were considered definite for donor origin and 4 were considered probable for donor origin. Thde classifications of 6 of the definite and 1 of the probable donor origin tumors were supported by molecular cytogenetic testing.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Registry Series
Deceased donor
Molecular typing
Therapy discussed
Donor derived
Prostate adenocarcinoma/carcinoma
Lung cancer, small cell
Lung cancer, type not specified
Renal cell carcinoma
Small bowel cancer, other or type not specified
Cholangiocarcinoma
Non-Standard Donor Risk
Risk estimates
Reference attachment:
Suggest references:
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 Apr 1. doi: 10.1097/TP.0000000000004117. Epub ahead of print. PMID: 35421045.
Note:
Uploaded MN 5/4/22
First review 5/30/2(if not appropriate delete the sentence with "personal communication" although this how Kerstin and me see it due to the known unawareness of all pitfalls caused by out collieagues not considering well all details - I do not know how to put it into words well). Secondly in table 4 I note 3 DTC with first symtoms > 42 mo. post TX -> can this be donor derived, I did not comment in the boxes because this confuses, but added the key word - if incorrect delete.)
Second review 6/7/2022 Author & MCS: deleted the sentence with "personal communication". Figures reviewed by author. Included new keywords: Non-Standard Donor Risk and risk estimates
Moved back to editing for discussion at our meeting 6/8/22: MN
Second review MN 11/21/23
Expert comments for publication:
This is a significant contribution to the area of donor cancer transmission. The authors combine donor data and posttransplant biovigilance data to provide a more accurate evidence based assessment of actual tumor transmission risk than is possible by simply considering recipient based events, which has been the general approach up to this time. Their approach also includes donors who had cancer but never transmitted it to recipients. In all cases, tumor transmission occurred when donor cancer was not discovered until after transplantation. This most commonly occurred when renal carcinoma was discovered while transplantation was occurring elsewhere, and less frequently when frozen section of a lesion at the time of transplant was misdiagnosed as benign, or additional information or donor autopsy results later became available. The most commonly transmitted cancer in this series was lung cancer, suggesting particular care in assessing these organs. The authors suggest that current guidance may overestimate the transmission risk for CNS tumors, and feel that organs from selected donors with prostate cancer are also usable. Of note, 31% of tumor transmissions in this series occurred after 2 years posttransplant, suggesting that continued followup of these patients is warranted.