Review article: Donor-Transmitted Cancer in Organ Transplant Recipients: A Systematic Review (2021)

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Record number: 
Adverse Occurrence type: 
Estimated frequency: 
N/A. This is a systematic review (as of January 2020) of published literature regarding reported donor transmitted cancer in orthotopic (heart, lung, liver) transplant recipients and does not include heterotopic (kidney, pancreas) recipients. Donor-derived tumors, which arise de novo post-transplant from donor cells, are not included. Tumor types reported include melanoma, choriocarcinoma, CNS tumors, genitourinary, hematologic, neuroendocrine and lung tumors, sarcomas, tumors of unknown primary site, intestinal tumors, breast, hepatocellular and pancreatic tumors. Please refer to Council of Europe guidelines for guidance regarding individual tumor types.
Time to detection: 
Range: 0 days - 6 years, Median 8 months, 66% detected within 1 year, 82% detected within 2 years.
Alerting signals, symptoms, evidence of occurrence: 
Not dealt with in detail. The authors note that allograft dysfunction is not a sensitive indicator of tumor. Additionally, examples of tumor presentation in distant sites without allograft involvement are noted.
Demonstration of imputability or root cause: 
This is a systematic review of documented cases of donor tumor transmission. “Donor derived” cancers in the recipient are excluded. It is notable that although the majority of cases occurred within the first two years, individual examples up to 6 years posttransplant are included in the donor transmitted category.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Review article
Deceased donor
Therapy discussed
Heart transplant
Lung transplant
Liver transplant
Carcinoma of unknown primary site
CNS tumor, other or type not specified
Reference attachment: 
Suggest references: 
Greenhall GHB, Ibrahim M, Dutta U, Doree C, Brunskill SJ, Johnson RJ, Tomlinson LA, Callaghan CJ, Watson CJE. Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review. Transpl Int. 2022 Feb 4;35:10092. doi: 10.3389/ti.2021.10092. PMID: 35185366; PMCID: PMC8842379.
Uploaded 4/17/22 MN First review CLFF 06/07/2022 second review 10/27/22
Expert comments for publication: 
The authors note the overall low level of evidence in this area, based mainly on the mostly anecdotal reports, and observe that this is unlikely to change. Therefore, publication bias remains a likely possibility. Based on their review, they offer several suggestions: 1. Since about 80% of donor transmitted cancers occur within 2 years posttransplant, surveillance of patients at risk for this complication should be stressed during this period. 2. Allograft dysfunction is an unreliable indicator of tumor recurrence and, although it does occur, it is not sensitive. 3. Retransplantation should be considered if the tumor is confined to the allograft, and tumor resection or locoregional therapy can also be considered based on the specific features of the patient. They note that there is a high overall mortality associated with this condition, with some variability based on tumor type, and many gaps in our knowledge remain. We would also add that full reporting of such cases will assist in accruing knowledge that will aid in informing future therapy, and suggest reference to this article for guidance in reporting such complications.