(Subject Review): Donor cancer transmission in kidney transplantation (Lung cancer, adenocarcinoma) (2013)

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Record number: 
1938
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
N/A. Literature review of various tumor types: systematic review of donor cancer transmission to kidney recipients up to December 2012 (69 studies included with 104 recipients): renal cancer (n=20), melanoma (n=18), lymphoma (n=15), lung cancer (n=9), sarcoma (n=7), Glioma (n=6), Choricarcinoma (n=5); other cancers (n=24). Please note that the cases have already been published in other studies and are summarized in this review for the outcome parameters: cancer specfic recipient survival, frequencies of metastasis at initial cancer diagnosis, time to cancer diagnosis, treatment modalities.
Time to detection: 
Time from transplantation to cancer detection in months: median-IQR: renal cancer (n=20: 10.5; 3.0-40.0), melanoma (n=18: 10.5; 8.0-16.5), lymphoma (n=15; 4.0; 0.8-7.0), lung cancer (n=9: 13.0; 11.0-17.0), sarcoma (n=7: 19.0; 14.3-20.0), glioma (n=6: 10.0; 10.0-17.0), choricarcinoma (n=5: 1.0; 0.2-3.0); other cancers (n=24: 8.0; 5.5-18.5). Except for glioma all other cancers were not known to implanting team at time of transplantation.
Alerting signals, symptoms, evidence of occurrence: 
Except for time to detection alerting signals and symptoms must be extracted from the original references. At time of diagnosis recipients with metastases were observed in renal cancer in 15% (n=3) cases, in melanoma in 72% (n=13) cases, in lymphoma in 7% (n=1) cases, in lung cancer in 78% (n=7) cases, in sarcoma in 71% (n=5) cases, in glioma in 17% (n=1) cases, in choricarcinoma in 40% (n=2) cases, other cancers in 71% (n=17) cases. Time interval from transplantation to recipient death (number of events; time in months: median; IQR) in renal cancer 3 of 17: 9.0: 6.7-9.5; in melanoma 13 of 18: 12.5; 10.1-17.8; in lung cancer 6 of 9: 25.0; 18.0-37.0; in lymphoma 1 of 15: 1. 1-1.
Demonstration of imputability or root cause: 
N/A. Details must be extracted from original references.
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
Subject review
Living donor
Deceased donor
Kidney transplant
Lymphoma/type not specified
Astrocytoma/glioblastoma multiforme (WHO grade 4)
Renal cell carcinoma
Sarcoma/other or type not specified
Melanoma
Choriocarcinoma
Lung cancer/adenocarcinoma
Malignancy
Suggest references: 
Xiao D, Craig JC, Chapman JR, Dominguez-Gil B, Tong A, Wong G. Donor cancer transmission in kidney transplantation: A systematic review. Am J Transplant 2013; 13:2645-2652.
Note: 
This paper can be used as the basis for several records, dealing with RCC (this one), lung cancer and melanoma, and maybe others. The paper is restricted to kidney recipient. Please check: harm to reciepient should include a mark at renal cell cancer, lymphoma, melanoma, choriocarcinoma, lung cancer, sarcoma. This record can be cloned for lymphoma, melanoma, choriocarcinoma, lung cancer, sarcoma Mike N. This record will be cloned for the 5 requested tumor types (EP)
Expert comments for publication: 
The authors conclude with the general consensus that organs from donors with a history of melanoma or lung cancer should be rejected for transplantation but state that their review suggests that use of donor kidneys with a history of small incidental renal cell cancers may be reasonable. Council of Europe recommendations for major tumors reviewed in this article: Renal cell carcinoma (Council of Europe, 2022): To provide valid histological staging, complete tumour resection (R0) is required for acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. Paraffin section is superior to frozen section for the assessment of such biopsies. The contralateral kidney should always be examined for synchronous RCC (5 % of patients). RCC < 1 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) can be considered minimal-risk for transmission; RCC 1-4 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered high-risk; RCC with extension beyond the kidney (stages T3/T4 AJCC 8th edn) is considered a contraindication to transplant; All RCC with WHO/ISUP grade III/IV (Fuhrman grade III/IV) are considered high-risk for transmission; Contralateral kidneys and other organs that are un¬involved in carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and WHO/ISUP grade I-II. In all cases, follow-up surveillance is desirable. Melanoma: Most recent risk assessment for melanoma (Council of Europe, 2022): Due to the very aggressive behaviour of this tumour, it is considered an unacceptable risk for organ donation. Malignant melanoma in the donor history: Due to the lack of exhaustive data, transplanting organs from donors with treated malignant melanoma must still be considered to be associated with a high transmission risk. If precise donor data about staging, therapy, follow-up and recurrence-free survival are available, and evaluation by the dermato-oncologist concludes there is a low probability of recurrence and metastasis, organ donation might be considered for selected recipients. Lymphoma: Most recent risk assessment for leukemia, lymphoma and plasmacytoma (Council of Europe, 2022): Leukaemia, lymphoma and plasmacytoma diagnosed during donor procurement: These cancers are classified as an unacceptable risk for organ donation. Leukaemia, lymphoma and plasmacytoma in the donor history: Active (acute or chronic) leukaemia, lymphoma and plasmacytoma are an unacceptable risk for organ donation. Treated acute leukaemia and lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission. Lung cancer: Most recent risk assessment for Lung Cancer (Council of Europe, 2022): Any histotype of newly-diagnosed lung cancer is an unacceptable risk for organ donation. Lung cancer in the donor history: Treated lung cancer is considered to be associated with a high transmission risk. Risk may decrease after curative therapy, with recurrence-free time and with increasing probability of cure. Sarcoma Most recent risk assessment for sarcoma (Council of Europe, 2018): Donors with active sarcoma are considered to represent an unacceptable risk for organ donation regardless of disease stage. Donors with a history of sarcoma are also generally considered to represent unacceptable risks for transmission. After curative therapy and recurrence free survival of more than five years, they are still assumed to be associated with a high risk for transmission. Gastrointestinal stromal tumors are not grouped with other sarcomas and are considered separately. Glioma and Astrocytoma (various WHO grades, in this study only WHO Grade IV considered): (Council of Europe, 2018): Potential donors with pilocytic astrocytoma (WHO grade I) may be considered for organ donation with minimal risk of transmission. Extra-neural metastases from low grade astrocytomas (WHO grade II) are rare, and have been associated with resection and ventriculo-peritoneal shunts. In the absence of these risk factors the donor may be considered minimal risk. Risk may increase with the extent of performed interventions. A complete histological examination of the tumour should be performed so that areas of more aggressive malignancy are ruled out. Since astrocytomas have a tendency to relapse with a histologically higher grade of malignancy, new histological examinations should be performed where relapse occurs to regrade the tumour. If the tumor co-exists with histological areas of greater malignancy or is very invasive locally, it should be considered high grade and will be associated with an increased risk of transmission. Spontaneous extra-neural metastases of anaplastic astrocytomas and glioblastoma multiforme are rare, but have been observed, and occur more frequently when associated with prior surgical treatment and/or ventriculo-peritoneal drainage, or chemo-/radiotherapy. Potential donors with anaplastic astrocytomas (WHO grade III) can be accepted as organ donors. Transmission risk is considered low to intermediate for tumours without any risk factors. Potential donors with glioblastoma multiforme (WHO grade IV) are considered intermediate to high risk for transmission depending on the different national recommendations, which are expected to be adjusted with increasing evidence. The transmission risk is increased (high risk) in all cases with previous interventions such as tumour resection, ventriculo-peritoneal/-atrial drainage and/or cranial chemo-/radiotherapy. Choricarcinoma: Most recent risk assessment for choriocarcinoma (Council of Europe, 2018): Potential donors with recently diagnosed choriocarcinoma represent an Unacceptable Risk for organ donation. Those with a history of choriocarcinoma represent a High or Unacceptable risk for organ donation due to the reported high transmission and mortality rates, depending upon recurrence free time, which is not clearly defined in the literature.