Collective experience with renal transplantation from donors with a history of breast cancer

Long waiting times have led to marked increases in living kidney donation and use of higher risk cadaver donors. Though donors with known malignancies are usually excluded to prevent transmission of neoplastic cells with the transplanted organ, it is not clear that the history of a serious but apparently cured cancer should permanently preclude donation. For tumors that typically recur within a reasonable, defined time period, the minimal length of time to wait might be determined, but in the case of tumors known to exhibit long delayed recurrence, such as breast cancer, the decision may be less straightforward. We reviewed our experience with transplantation of kidneys obtained from donors with a history of breast cancer. Results: Overall, nine patients (3 women, 6 men) received organs from 8 female donors from December 1970 through November 1999. The mean follow-up was 40.1 months, with 6 survivors followed for a mean of 57.3 months. Three transplants from 2 cadaver donors occurred prior to 1980 (ERA I), with early deaths in all at 2, 2.5 and 12 months. One of these recipients developed breast cancer 4 months following txp that ultimately led to his demise. All six txp in Era II (after 1980) came from live donors. In 4/6 ERA II txp, early stage tumors were apparently cured prior to organ donation (53, 84, 96, unknown months). Two advanced tumors were identified in women at 0.3 (Stage IV) and 16 months (Stage III) following donation. ERA II recipients have experienced 100% survival, though the single patient with an organ from a donor with metastatic disease 1/6 (17%) also developed metastatic breast cancer at 12.6 months after transplant. The lesion disappeared with use of Tamoxifen and the cessation of immunosuppression, and the patient has experienced a disease free interval of 36 months. Conclusions: Txp of cadaver kidneys from donors with breast cancer is unlikely to permit adequate time either to accomplish a metastatic survey, or to assist an unprepared candidate to fully consider the risk of cancer transmission, which is substantial, and may not be reasonable. However, kidney transplantation from live donors with a remote history (> 48 months) of early stage breast cancer may be appropriate in the presence of informed consent and the absence of an alternate donor. Tumor transmission, though devastating, may be amenable to hormonal manipulation combined with cessation of immunosuppression.