Corneal transplantations from donors with cancer

BACKGROUND: Acceptance criteria for corneal donation in some eye banks include cadavers with active cancer, both solid and hematological. Such acceptance is based on the fact that the cornea is an avascular tissue and metastatic dissemination is extremely unlikely. METHODS: From a total of 588 corneal donors in the Sant Pau Tissue Bank (April 1999 to December 2003), 204 (34.7%) had an active malignancy or a history of malignancy. Of these, 177 had solid cancers and 27 had hematological cancers. Cancer was active in 94.7% and 64% had metastatic dissemination. A histopathological study of the 408 eyes from these 204 donors was performed to rule out metastasis. A total of 325 corneas (79.7%) were transplanted and recipients were followed for an average of 64.1 months (SD 11.1, range 30-86). RESULTS: The incidence of ocular metastases in the 204 donors with malignancy was 1%, 0.6% for solid cancer, and 3.7% for malignant hematological disease. There was no tumor transmission in any of the 325 recipients. CONCLUSIONS: The incidence of ocular metastases in corneal donors with active malignancy is very low. Donor-recipient tumor transmission through corneal transplantation is highly improbable when the eyes are free of cancer.