Single center series: Liver transplant from donors with genitourinary (renal cell or prostate) cancer (2017)

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MPHO Type: 
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Renal cell carcinoma: Most recent risk assessment for 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 ed) 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 ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th ed) 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 ed) 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. RCC in the donor history: The transmission risk of treated RCC depends on the histological type of tumour [159] and its recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease. Prostate carcinoma: Most recent risk assessment for prostate cancer (Council of Europe, 2022): If Gleason score is available, e.g., prostate diagnostics have been initiated a few days before organ procurement, then small intra-prostatic, low-grade (Gleason score ≤ 6) tumours are considered minimal-risk; intra-prostatic tumours with Gleason score 7 are considered low-to-intermediate risk; and intra-prostatic (pT2c) tumours with Gleason score > 7 are considered high-risk. Histological examination of the entire prostate with a valid grading of the tumour is time-consuming and the results might not always be available before an organ is transplanted. Donors with extra-prostatic tumour extension should be unequivocally excluded from the donation process as an unacceptable risk. Prostate cancer in the donor history: The acceptable time intervals for complete remission of prostate cancer are strongly correlated with stage and Gleason grade of the tumour. Donors with a history of curatively treated prostate cancer ≤ pT2 (tumour confined to prostate) and Gleason 3 + 3, as well as donors with very small prostate cancers and Gleason 3 + 3 under ‘active surveillance’, can be accepted for organ donation as minimal transmission risk at any time after diagnosis with the prerequisite of a frequently performed and non-suspicious follow-up. Prostate cancer < pT2 (confined to the prostate) and Gleason grade < 7 after curative treatment and cancer-free period > 5 years is considered minimal-risk. Higher stages/grades and/or shorter cancer-free periods require an individual risk assessment. A history of extra-¬prostatic tumour extension poses a high risk for transmission. In any case, current PSA values should be obtained to compare to former ones and to assess the actual situation.
Time to detection: 
Alerting signals, symptoms, evidence of occurrence: 
Donor examination during procurement
Demonstration of imputability or root cause: 
Donor examination during procurement
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Single Center Series
Liver transplant
Deceased donor
Histologic analysis
Renal cell carcinoma
Prostate adenocarcinoma/carcinoma
Donor cancer without transmission
Suggest references: 
Pezzati D, Ghinolfi D, Lai Q, Cirillo G, Rreka E, Roffi N, et al. Use of donors with genitourinary malignancies for liver transplantation: a calculated risk? Transpl Int. 2017;30(7):737-9.
please clone record for prostatic cancer and renal cell carcinoma, Do not link this file to urothelial carcinoma. Please do not link to urothel carcinoma (as this is not covered by the study 1/3/19 MN- 2nd review: A few comments. I am adding a new keyword :Donor cancer without transmission" as a first effort to address this recurrent problem that we have. I still think we should add this as a subheading under "risk of harm", but one problem I see with that is that it would call up all non-transmitted donor cancers- kidney, lung, stomach, big toe, etc., and a search would give a wide variety of reports without answering the obvious question of the user, which is: "what is the risk of transmission with this particular type of cancer that my donor has?" Also, please clone the record listing "prostate adenocarcinoma/carcinoma" under harm to recipient - Done (EP) OK to upload.
Expert comments for publication: 
The authors report the outcome of liver transplantation (LTX) between 2005 and 2014 using donors with incidental prostatic cancer (PC, n=43 of 1042 cases) or renal cell carcinoma (all < 2cm; RCC, n=41 of 1042 cases) detected during procurement. No transmission was observed at a median patient survival of 5.6 years. The authors conclude that based on the low risk of metastatic potential of such malignancies, such livers should not be discarded after careful donor evaluation (excluding metastatic diseases before and during procurement as well as proper histopathologic workup). An unresolved issue is the risk of RCC transmission with small multifocal or bilateral donor RCC. Noteworthy are the details of the tumors in the donors: all RCC are classified as minimal risk (n=36) or low risk (n=5) according to guidelines (e.g. CoE guide, UNOS/OPTN, CNT) as well as for prostate cancer minimal risk (n=32), low-intermediate risk (n=5) and high risk (n=6) respectively. The absence of tumor transmission by liver transplantation in this setting is consistent with other reports of donor intra-prostatic or small solitary renal cancers, although it should be considered that the risk of tumor transmission, although apparently miniscule, is probably not zero. Therefore appropriate informed consent is important. It is also important to reasonably rule out the possibility of metastatic disease prior to transplant.