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

Eccher, Albino; Girolami, Ilaria; Motter, Jennifer D.; Marletta, Stefano; Gambaro, Giovanni; Momo, Rostand Emmanuel Nguefuet; Nacchia, Francesco; Donato, P.; Boschiero, Luigino; Boggi, Ugo; Lombardini, Letizia; Cardillo, Massimo; D’Errico, Antonietta; Neil, Desley; Segev, Dorry L.; Zaza, Gianluigi

doi:10.1007/s40620-020-00775-4

Cited by 40 publications

(29 citation statements)

References 25 publications

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“…Taken in the context of existing research, our study confirms that the prognosis of DTC in orthotopic SOTRs is worse than in heterotopic transplant recipients (12,27). The outcomes of the heterotopic SOTRs with DTC from the same donors as our included cases appear to confirm this.…”

Section: Discussionsupporting

confidence: 86%

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

et al. 2022

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Donor-transmitted cancer (DTC) has major implications for the affected patient as well as other recipients of organs from the same donor. Unlike heterotopic transplant recipients, there may be limited treatment options for orthotopic transplant recipients with DTC. We systematically reviewed the evidence on DTC in orthotopic solid organ transplant recipients (SOTRs). We searched MEDLINE, EMBASE, PubMed, Scopus, and Web of Science in January 2020. We included cases where the outcome was reported and excluded donor-derived cancers. We assessed study quality using published checklists. Our domains of interest were presentation, time to diagnosis, cancer extent, management, and survival. There were 73 DTC cases in liver (n = 51), heart (n = 10), lung (n = 10) and multi-organ (n = 2) recipients from 58 publications. Study quality was variable. Median time to diagnosis was 8 months; 42% were widespread at diagnosis. Of 13 cases that underwent re-transplantation, three tumours recurred. Mortality was 75%; median survival 7 months. Survival was worst in transmitted melanoma and central nervous system tumours. The prognosis of DTC in orthotopic SOTRs is poor. Although re-transplantation offers the best chance of cure, some tumours still recur. Publication bias and clinical heterogeneity limit the available evidence. From our findings, we suggest refinements to clinical practice.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020165001, Prospero Registration Number: CRD42020165001.

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Section: Discussionsupporting

confidence: 86%

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

et al. 2022

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“…[ 29 ] Indicating the precise percentage of glomerulosclerosis in addition to the specific locations, instead of indicating approximately the range (20%–50%), may be decisive in the organ allocation. Furthermore, while transplantation carries an unavoidable risk of transmission of malignant diseases from donor to recipient,[ 30 31 ] the digital system opens the way to a real-time, fast, and reliable consultation and quality control assessment of diagnoses provided by pathologists in the time constraints of transplant.…”

Section: Discussionmentioning

confidence: 99%

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

Neri

Eccher²,

Rigotti

et al. 2021

Journal of Pathology Informatics

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Background: In the setting of kidney transplantation, histopathology of kidney biopsies is a key element in the organ assessment and allocation. Despite the broad diffusion of the Remuzzi–Karpinski score on preimplantation kidney biopsies, scientific evidence of its correlation to the transplantation outcome is controversial. The main issues affecting the prognostic value of histopathology are the referral to general on-call pathologists and the semiquantitative feature of the score, which can raise issues of interpretation. Digital pathology has shown very reliable and effective in the oncological diagnosis and treatment; however, the spread of such technologies is lagging behind in the field of transplantation. The aim of our study was to create a digital online platform where whole-slide images (WSI) of preimplantation kidney biopsies could be uploaded and stored. Methods: We included 210 kidney biopsies collected between January 2015 and December 2019 from the joint collaboration of the transplantation centers of Padua and Verona. The selected slides, stained with hematoxylin and eosin, were digitized and uploaded on a shared web platform. For each case, the on-call pathologists' Remuzzi grades were obtained from the original report, together with the clinical data and the posttransplantation follow-up. Results: The storage of WSI of preimplantation kidney biopsies would have several clinical, scientific, and educational advantages. The clinical utility relies on the possibility to consult online expert pathologists and real-time quality checks of diagnosis. From the perspective of follow-up, the archived digitized biopsies can offer a useful comparison to posttransplantation biopsies. In addition, the digital online platform is a precious tool for multidisciplinary meetings aimed both at the clinical discussion and at the design of research projects. Furthermore, this archive of readily available WSI is an important educational resource for the training of professionals. Conclusions: Finally, the web platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome.

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“…The most commonly transmitted cancer types are lymphoma (20.5%), renal cancer (17.9%), melanoma (17.1%) and lung cancer (10.3%). Melanoma and lung cancer have poor prognoses, with 5-year overall survival (OS) rates of 43 and 19%, respectively; meanwhile, renal cancer and lymphomas have favorable prognoses, with respective 5-year OS rates of 93 and 63% [ 8 ]. The incidence of sarcoma transmission is much lower; only a few cases of Kaposi’s sarcoma transmission have been reported [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Transmission of synovial sarcoma from a single multi-organ donor to three transplant recipients: case report

Zhang

Yang

et al. 2021

Diagn Pathol

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Background Transmission of malignancy is a notable problem that cannot always be absolutely predicted at the time of transplantation. In particular, donor-derived transmission of synovial sarcoma in solid-organ transplantation is a rare but catastrophic event. Case presentation We are the first to report three cases of synovial sarcoma transmitted from a single multi-organ donor in China. The donor died of respiratory failure caused by an intrathoracic tumor, which was diagnosed as benign at the time of donation. All three recipients developed synovial sarcoma 3–13 months after transplantation; all three cases were confirmed to be donor transmitted. The liver transplant recipient died of tumor metastasis after partial-allograft hepatectomy. The two renal-transplant recipients survived after comprehensive therapy, including allograft nephrectomy, withdrawal of immunosuppressants and targeted therapy with anlotinib. Conclusions This report highlights the importance of detailed donor assessment, close follow-up and timely treatment of unexpected donor-transmitted malignancy. Although pathology is the most important evidence for the exclusion of donors for malignant potential, it should be combined with tumor type, tumor size and speed of growth. Organs from donors with malignant potential should be discarded. Allograft nephrectomy should be considered after confirmation of renal-allograft synovial sarcoma. Anlotinib for synovial sarcoma seems to be effective and well tolerated during long-term follow-up.

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

Cited by 40 publications

References 25 publications

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

Transmission of synovial sarcoma from a single multi-organ donor to three transplant recipients: case report

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