Cancer transmission from organ donors-unavoidable but low risk

Transplantation. 2012 Dec 27;94(12):1200-7. doi: 10.1097/TP.0b013e318272df41.

Abstract

Background: Donor origin cancer (DOC) in transplant recipients may be transmitted with the graft (donor-transmitted cancer [DTC]) or develop subsequently from the graft (donor-derived cancer [DDC]).

Methods: Recipients with DOC between January 1, 2001, and December 31, 2010, were identified from the United Kingdom Transplant Registry and database search at transplantation centers.

Results: Of 30,765 transplants from 14,986 donors, 18 recipients developed DOC from 16 donors (0.06%): 3 were DDC (0.01%) and 15 were DTC (0.05%). Of the 15 DTCs, 6 were renal cell cancer; 5, lung cancer; 2, lymphoma; 1, neuroendocrine cancer; and 1, colon cancer. Recipients with DTC underwent explant/excision (11), chemotherapy (4), and radiotherapy (1). Of 15 recipients, 3 (20%) recipients with DTC died as a direct consequence of cancer. Early DTC (diagnosed ≤6 weeks of transplantation) showed a better outcome (no DTC-related deaths in 11 cases) as opposed to late DTC (DTC-related deaths in 3 of 4 cases). Five-year survival was 83% for kidney recipients with DTC compared with 93% for recipients without DTC (P=0.077). None of the donors resulting in cancer transmission was known to have cancer at donation.

Conclusions: DTC is rare but frequently results in graft loss and death. The risk of cancer transmission cannot be eliminated because, in every case, the presence of cancer was not known at donation. This information will allow informed consent for prospective recipients. Explantation/excision is likely to benefit recipients with localized cancer, but in transplants other than kidney/pancreas, the benefits should be balanced against the risks of retransplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carcinoma, Renal Cell / etiology
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Transitional Cell / etiology
  • Carcinoma, Transitional Cell / mortality
  • Female
  • Heart Transplantation / adverse effects
  • Heart Transplantation / mortality
  • Heart Transplantation / statistics & numerical data
  • Humans
  • Incidence
  • Kidney Neoplasms / etiology
  • Kidney Neoplasms / mortality
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / mortality
  • Kidney Transplantation / statistics & numerical data
  • Liver Transplantation / adverse effects
  • Liver Transplantation / mortality
  • Liver Transplantation / statistics & numerical data
  • Lymphoma / etiology
  • Lymphoma / mortality
  • Male
  • Middle Aged
  • Neoplasms / etiology*
  • Neoplasms / mortality*
  • Organ Transplantation / adverse effects*
  • Organ Transplantation / mortality
  • Organ Transplantation / statistics & numerical data
  • Pancreas Transplantation / adverse effects
  • Pancreas Transplantation / mortality
  • Pancreas Transplantation / statistics & numerical data
  • Registries / statistics & numerical data
  • Risk Factors
  • Survival Analysis
  • Tissue Donors / statistics & numerical data*
  • United Kingdom / epidemiology