Cancer transmissions and non‐transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors

Hedley, James; Vajdic, Claire M.; Wyld, Melanie; Waller, Karen; Kelly, Patrick J.; Mata, Nicole De La; Rosales, Brenda; Wyburn, Kate; Webster, Angela C

doi:10.1111/tri.13989

Cited by 9 publications

(13 citation statements)

References 14 publications

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“…A landmark international study reported a much higher brain tumor transmission risk of 23%, although an unreliable denominator is likely to have inflated this estimate . Our results are consistent with those of recent studies, which found transmission risks of less than 3% . A major limitation of the existing evidence is data quality.…”

Section: Discussionsupporting

confidence: 78%

Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission

et al. 2023

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ImportanceCancer 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.ObjectiveTo 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 ParticipantsThis 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.ExposuresA history of primary brain tumor in the organ donor, identified from all 3 data sources using disease codes.Main Outcomes and MeasuresTransmission 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.ResultsThis 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 RelevanceResults 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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Section: Discussionsupporting

confidence: 78%

Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission

et al. 2023

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“…15 SAFEBOD has previously been used to identify missed donation opportunities relating to blood borne viruses 16 and to identify transplants resulting in cancer transmission and nontransmission. 17 …”

Section: Methodsmentioning

confidence: 99%

Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

Hedley

Kelly

Waller

et al. 2022

Transplantation Direct

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“…[10][11][12][13] Mandatory registries, where both numerator and denominator are known, reveal that the frequency of DTC ranges from 0 to 6 cases per 10 000 transplants, and that DTC is usually unknown in the donor before transplantation. [14][15][16][17][18][19][20][21][22][23][24][25][26] One of these studies described the Spanish experience during 1990-2006, reporting a rate of 6 DTCs per 10 000 solid organ transplants. 19 Since then, important changes have occurred in the profile of deceased organ donors in the country, who are becoming older.…”

Section: Introductionmentioning

confidence: 99%

Malignancies in Deceased Organ Donors: The Spanish Experience

et al. 2022

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Background. To better define the risk of malignancy transmission through organ transplantation, we review the Spanish experience on donor malignancies. Methods. We analyzed the outcomes of recipients of organs obtained from deceased donors diagnosed with a malignancy during 2013–2018. The risk of malignancy transmission was classified as proposed by the Council of Europe. Results. Of 10 076 utilized deceased donors, 349 (3.5%) were diagnosed with a malignancy. Of those, 275 had a past (n = 168) or current (n = 107) history of malignancy known before the transplantation of organs into 651 recipients. Ten malignancies met high-risk criteria. No donor-transmitted cancer (DTC) was reported after a median follow-up of 24 (interquartile range [IQR]: 19–25) mo. The other 74 donors were diagnosed with a malignancy after transplantation. Within this group, 64 donors (22 with malignancies of high or unacceptable risk) whose organs were transplanted into 126 recipients did not result in a DTC after a median follow-up of 26 (IQR: 22–37) mo, though a prophylactic transplantectomy was performed in 5 patients. The remaining 10 donors transmitted an occult malignancy to 16 of 25 recipients, consisting of lung cancer (n = 9), duodenal adenocarcinoma (n = 2), renal cell carcinoma (n = 2), extrahepatic cholangiocarcinoma (n = 1), prostate cancer (n = 1), and undifferentiated cancer (n = 1). After a median follow-up of 14 (IQR: 11–24) mo following diagnosis, the evolution was fatal in 9 recipients. In total, of 802 recipients at risk, 16 (2%) developed a DTC, which corresponds to 6 cases per 10 000 organ transplants. Conclusions. Current standards may overestimate the risk of malignancy transmission. DTC is an infrequent but difficult to eliminate complication.

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Cancer transmissions and non‐transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors

Cited by 9 publications

References 14 publications

Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission

Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission

Perceived Versus Verified Cancer History and Missed Opportunities for Donation in an Australian Cohort of Potential Deceased Solid Organ Donors

Malignancies in Deceased Organ Donors: The Spanish Experience

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