Single center series: Prostate carcinoma and liver transplant (2018)

Status: 
Ready to upload
Record number: 
2031
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
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: 
N/A
Alerting signals, symptoms, evidence of occurrence: 
None
Demonstration of imputability or root cause: 
None
Imputability grade: 
0 Excluded
Groups audience: 
Suggest new keywords: 
Malignancy
Donor cancer without transmission
Single center series
Deceased donor
Liver transplant
Prostate adenocarcinoma/carcinoma
Suggest references: 
Skalski M, Gierej B, Nazarewski L, Ziarkiewicz-Wroblewska B, Zieniewicz K. Prostate Cancer in Deceased Organ Donors: Loss of Organ or Transplantation With Active Surveillance. Transplant Proc. 2018;50(7):1982-4.
Note: 
Please also clone record under: Adverse occurrence type: Unsuitable MPHO released for clinical use- no harm - OK (EP)
Expert comments for publication: 
This single center series reported 8 patients who received liver transplants from donors who were ultimately found to have prostate carcinoma. In all cases the Gleason score was 3+3 and tumor was restricted to the prostate. One recipient died of unrelated causes after transplant; no tumor transmission was found in the other 7 (followup 2-24 months, median 6 months). The authors suggest that these organs from early stage prostate cancer donors are suitable for transplant and that the recipients should be followed. They note that PSA has shortcomings in predicting prostate cancer, and biopsy at the time of transplant does not have a well-defined role.