Status:
Ready to upload
Record number:
2141
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
N/A: This retrospective Registry review of USA UNOS data examines potential donor tumor transmission in the specific case of donors with a history of cancer and heart transplantation.
Time to detection:
N/A. No transmission is documented, but the authors note that some recipients did develop cancer and they were not able to ascertain if this was of donor or recipient origin.
Alerting signals, symptoms, evidence of occurrence:
N/A
Demonstration of imputability or root cause:
N/A. The study examined heart transplantation from donors with and without a history of cancer of various types.
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Registry series
Deceased donor
Heart transplant
Donor cancer without transmission
History of cancer
Reference attachment:
Suggest references:
Rudasill, SE, Iyengar, A, Sanaiha, Y, et al. Donor history of malignancy: A limited risk for heart transplant recipients. Clin Transplant. 2020; 34:e13762. https://doi.org/10.1111/ctr.13762
Note:
First review MN 10/18/21
second review CLFF 06/May/2022, (independent read, agree, for CoE guide/guidelines developers: we should mention the statistical bias, that donors with previous malignancies in registries are more likely to be older+with more co morbities). I could add two files with one study from Germany (where we had no significant difference regarding donor malignancy with equivalent results at a smaler number of cases - but we did not discussed this exhaustively:) 174. Kutschmann M, Fischer-Fröhlich CL, Schmidtmann I et al. The joint impact of donor and recipient parameters on the outcome of heart transplantation in Germany after graft allocation. Transpl Int 2014;27(2):152-61, 175. Fischer-Fröhlich CL, Kutschmann M, Schmidtmann I. et al. Outcome of heart transplantation in Germany: details to be considered beyond multivariate analysis to improve the quality of graft allocation. Organs, Tissues and Cells 2014;17:53-61
Expert comments for publication:
This retrospective study of UNOS registry data (1987-2016) examined outcomes of 38,781 heart transplants, of which 622 came from donors with a history of malignancy. Donor malignancies were broadly divided into CNS and non-CNS types, and stratified for evidence of prior active donor malignancy within 1 year, 1-5 years, >5 years, and unknown time prior to transplant. The authors found increased 10 year mortality in recipients of heart from donors with a history of cancer. However, this was due to an increase in deaths during the first post-transplant year, and deaths were unrelated to cancer. Deaths were mainly due to graft failure, infection or multiple organ failure. When recipients who died during the first year were removed from analysis, no difference in survival was seen. The authors note that donors with cancer tended to be older and more likely to have significant hypertension. They recommend that careful evaluation of risks and benefits continue to be performed when considering heart transplant from a donor with a history of cancer, but that other donor risk factors, particularly those related to expanded criteria, may need to be re-evaluated and should also be taken into consideration. They acknowledge the limitations of their study as based on retrospective registry data; this is a thoughtful study worth examining despite these limitations and the fact that it deals with survival and not individual cancer types.