Molecular Insights in Transmission of Cancer From an Organ Donor to Four Transplant Recipients

Abstract

Organ donors are systematically screened for infection, whereas screening for malignancy is less rigorous. The true incidence of donor-transmitted malignancies is unknown due to a lack of universal tumor testing in the posttransplant setting. Donor-transmitted malignancy may occur even when not suspected based on donor or recipient factors, including age and time to cancer diagnosis. We describe the detection of a gastrointestinal adenocarcinoma transmitted from a young donor to 4 transplant recipients. Multidimensional histopathologic and genomic profiling showed a CDH1 mutation and MET amplification, consistent with gastric origin. At the time of writing, one patient in this series remains alive and without evidence of cancer after prompt organ explant after cancer was reported in other recipients. Because identification of a donor-derived malignancy changes management, our recommendation is to routinely perform short tandem repeat testing (or a comparable assay) immediately upon diagnosis of cancer in any organ transplant recipient. Routine testing for a donor-origin cancer and centralized reporting of outcomes are necessary to establish a robust evidence base for the future development of clinical practice guidelines.

Case report: A successful clinical experience of transplantation of liver and kidney from a donor with myelodysplastic syndromes

“…Prior to this, there has been little high-level evidence to predict the true rate of transmission ( 5 ). The US Donor Transmission Advisory Committee has recommended stratifying the risk of tumor types based on the available data of all solid organ transplants and has acknowledged a shortage of strong evidence for malignancy transmission rates by organ ( 6 ). Donors with a history of malignancy may be fit for expanding the pool of donors, especially in minimizing potential donor transmitted malignancies.…”