Outcomes of Organ Transplantation from Donors with a Cancer History

Abstract

BackgroundThe 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/MethodsRetrospective 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.ResultsDWCH 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.ConclusionsUnder 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.

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

“…51−54 Donor malignancy has not been shown to have an increased risk of early death or graft loss overall in solid organ transplant recipients, although hematologic and otolaryngotic tumors have been associated with decreased survival following heart transplant. 55 The Organ Procurement and Transplantation Network has issued a consensus statement on donor malignancy. 56 There are only case reports of genetic syndromes in donors and no conclusions can be drawn.…”

Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: A review of the literature

“…Although far less common, donors with active or prior malignancy history are another potential source for organ donation with disease transmission. The largest study assessing this risk evaluated over 8000 potential Chinese donors across all age ranges with a positive cancer history resulting in over 700 organ transplants . While there was no increased incidence of cancer transmission, they found significantly worse survival in heart transplant recipients from donors with either hematologic or otorhinolaryngologic cancers but not with central nervous system tumors.…”

Review of the impact of donor characteristics on pediatric heart transplant outcomes

“…While a comprehensive exploration of all other donor comorbidities is not possible in this review, some other pertinent situations were considered. The presence of a donor history of oncologic disease was reviewed as a risk factor for solid organ transplantation using a retrospective review of the Scientific Registry of Transplant Recipients (SRTR) database showed no increased risk of early death or graft loss in recipients of a donor with oncologic history . Although notably, hematologic and otolaryngotic tumors were associated with decreased recipient survival following heart transplantation …”