Use of donors with genitourinary malignancies for liver transplantation: a calculated risk?

Pezzati, Daniele; Ghinolfi, Davide; Lai, Quirino; Cirillo, Giulia; Rreka, Erion; Roffi, Nicolò; Carrai, P; Ringressi, Andrea; Simone, Paolo De; Filipponi, Franco

doi:10.1111/tri.12962

Cited by 4 publications

(8 citation statements)

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“…The UNOS described no DTC in a series of recipients of organs obtained from 147 donors with an RCC suspected at the time of transplant. 39 This large experience confirmed previous data from registry studies [17][18][19]22,[40][41][42] and single-center series, [43][44][45] as well as our own data. Precise RCC staging was lacking in most of these reports, but it is likely that nonrenal organs were accepted when RCC was diagnosed at an early stage or transplants were already being performed when information about the donor RCC became available.…”

Section: Discussionsupporting

confidence: 88%

“…More recently, an Italian group reported their experience with 5 liver transplants from deceased donors with Gleason scores 8 and 9, without DTC. 43 The previous findings reassure us about the safety of using organs from selected donors with prostate cancer. However, a liver recipient was diagnosed with a transmitted prostate cancer 5 mo after transplantation.…”

Section: Discussionmentioning

confidence: 80%

“…More recently, an Italian group reported their experience with 5 liver transplants from deceased donors with Gleason scores 8 and 9, without DTC. 43…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, several studies have reported no case of DTC after the transplantation of organs obtained from donors diagnosed with prostate cancer Gleason score ≤6 or 7. 21,23,43,44,[50][51][52][53] In a literature review, Doerfler et al 54 identified 120 solid organ transplants from donors with confirmed prostate cancer without any case of DTC. More recently, an Italian group reported their experience with 5 liver transplants from deceased donors with Gleason scores 8 and 9, without DTC.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 80%

“…More recently, an Italian group reported their experience with 5 liver transplants from deceased donors with Gleason scores 8 and 9, without DTC. 43…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Malignancies in Deceased Organ Donors: The Spanish Experience

et al. 2022

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“…100 More recently, an Italian group reported their experience with 5 LTs from deceased donors with Gleason scores 8 and 9, without DTC. 97…”

Section: The Risk Of Donor-transmitted Cancer In Liver Transplantatio...mentioning

confidence: 99%

Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference

et al. 2021

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As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to have a current or past history of malignancy. The frequency of DTCs is consistently reported at 3-6 cases per 10 000 solid organ transplants, with a similar frequency in the LT setting. A majority of DTCs are occult cancers unknown in the donor at the time of transplantation. Most DTCs are diagnosed within 2 y after LT and are associated with a 51% probability of survival at 2 y following diagnosis. The probability of death is greatest for DTCs that have already metastasized at the time of diagnosis. The International Liver Transplantation Society-Sociedad Española de Trasplante Hepático working group on DTC has provided guidance on how to minimize the occurrence of DTCs while avoiding the unnecessary loss of livers for transplantation both in deceased and living donor LT. The group endorses the Council of Europe classification of risk of transmission of cancer from donor to recipient (minimal, low to intermediate, high, and unacceptable), classifies a range of malignancies in the liver donor into these 4 categories, and recommends when to consider LT, mindful of the risk of DTCs, and the clinical condition of patients on the waiting list. We further provide recommendations to professionals who identify DTC events, stressing the need to immediately alert all stakeholders concerned, so a coordinated investigation and management can be initiated; decisions on retransplantation should be made on a case-by-case basis with a multidisciplinary approach.(Transplantation 2022;106: e12-e29).

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The pursuit of happiness: The thin line between rights and duties

Ghinolfi

Simone

2018

American Journal of Transplantation

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We read with some concern the paper by Halazun et al on the use of elderly liver grafts in the United States. 1 Even if more and more evidence is being accumulated about the favorable outcomes of liver transplantation from very old donors, 2 barriers to a wider use still exist and include both Organ Procurement Organization's rules and skepticism from physicians. In 2015, 1673 patients (12.0%) died in the United States while waiting for a liver transplant, and 1227 (8.7%) were delisted due to increased severity of disease. Organ Sharing (UNOS) database, 6 we recently showed that donor diabetes mellitus and cold ischemia time are independent risk factors for lower graft survival after elderly graft liver transplantation. 5 Use of liver grafts from elderly donors should undergo a learning period at any local transplant center, and graft histology is pivotal and should be combined with both surgical exploration and laboratory data. In fact, the gross anatomy of very old donor liver grafts

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Use of donors with genitourinary malignancies for liver transplantation: a calculated risk?

Cited by 4 publications

References 4 publications

Malignancies in Deceased Organ Donors: The Spanish Experience

Malignancies in Deceased Organ Donors: The Spanish Experience

Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference

The pursuit of happiness: The thin line between rights and duties

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