Cancer in the organ donor
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1 Cancer in the organ donor Pr Olivier Detry Dpt of Abdominal Surgery & Transplanta>on CHU Liège, University of Liege, Belgium
2 Conflicts of Interest
3 Conflicts of Interest Active waiting list (at year-end) in Belgium, by year, by organ Active waiting list kidney heart lung liver pancreas Total patients statistics.eurotransplant.org : 3022P_Belgium : : patients waiting for multiple organs are counted for each organ Eurotransplant annual report 2017
4 Conflicts of Interest Waiting list mortality in Belgium, by year, by organ kidney heart lung liver pancreas Total events Total patients statistics.eurotransplant.org : 4512P_Belgium : : Reported by year of death. Includes patients with active or non-active urgency at removal. Includes removals while waiting for living or deceased donor transplants. Eurotransplant annual report 2017
5 Tumours in the donor: what is the risk? Cancer can be transmired by organ transplanta>on
6 Tumours in the donor: what is the risk? Cancer can be transmired by organ transplanta>on Cancer can be transmired otherwise - mother- to- fetus - fetus to fetus (twins) - daughter to mother - pa>ent to surgeon
7 Calcineurin inhibitors Guba et al. Transplanta>on 2004
8 Organ dona>on & donor cancer Pa>ents diagnosed with neoplasia should not be considered for organ dona>on, except: - low grade skin tumours - in situ carcinoma of the uterine cervix - primary CNS tumours (except high grade) - low- malignancy grade kidney tumours Council of Europe. In «Guide to safety and quality assurance for the transplanta>on of organs, >ssue and cells.» 4th edi>on 2011
9 Past tumors in the donor: what is the risk with Tx?
10 Case reports Tx & Cancer Transmission
11 Case reports Tx & Cancer Transmission Registries - Prospec>ve: UNOS, UK, Australia, Italy, Spain - Volontary: IPPTR
12 2 categories Cadaveric donor with past history of non CNS cancer Cadaveric donor with past history of CNS cancer
13 Cadaveric donor with past history of non CNS cancer According to several published guidelines & Council of Europe 2011: no organ dona>on
14 Cadaveric donor with past history of non CNS cancer According to several published guidelines & Council of Europe 2011: no organ dona>on In most (all?) reported cases of non- CNS cancer transmission with organ transplanta>on in these last 20 years, none were known before dona>on!
15 UNOS ,705 deceased donors 257 deceased donors with history of cancer 650 organs Mean follow- up: 45 months Kauffman et al. Transplanta>on 2000
16 UNOS Kauffman et al. Transplanta>on 2000
17 UNOS No transmission of cancer in the recipients!
18 UNOS ,455 deceased donors 1,069 deceased donors with history of cancer 2,508 organs Kauffman et al. Transplanta>on 2007
19 UNOS TABLE 1. Deceased donor transplants from donors with a past history of cancer (n 1069), 2000 to 2005 Donor cancer type Deceased donor transplants Total Kidney Liver Heart Lung Heart lung Pancreas Kidney pancreas Skin (basal, squamous) Melanoma CNS: glioblastoma multiforme CNS: astrocytoma CNS: meningioma CNS: pituitary CNS: ependymoma CNS: oligodendroglioma CNS: other Uterine cervix Breast Prostate Uterine endometrial Bladder Ovarian Testicular Kidney Colorectal Thyroid Tongue/throat Lung Leukemia/lymphoma Other, specify Total
20 UNOS TABLE 1. Deceased donor transplants from donors with a past history of cancer (n 1069), 2000 to 2005 Donor cancer type Deceased donor transplants Total Kidney Liver Heart Lung Heart lung Pancreas Kidney pancreas Breast Prostate Uterine endometrial Bladder Ovarian Testicular Kidney Colorectal Thyroid Tongue/throat Lung Leukemia/lymphoma Other, specify Total Kauffman et al. Transplanta>on 2007
21 UNOS cases of transmissions of cancer to the recipients: - glioblastoma: kidney, liver, lung - melanoma: (32 years of follow- up) (unknown at the >me of procurement and transplanta>on) Kauffman et al. Transplanta>on 2007
22 UNOS ATS 2013 Abstract #D ,946 organ transplanta>ons 1,360 donors with history of cancer living donors deceased donors (55%CNS) No increased risk of cancer in the recipients 2 cases of transmired cancer from living dona>on KTx (myeloma & melanoma)
23 NHS NHS ,639 organ donors 202 donors with history of cancer High risk cancers in 61 donors (133 recipients) breast:10, melanoma: 3, lymphoma: 5; colon: 3; ovary: 2; sarcoma: 4; CNS: 34 Desai et al. Br J Surg, 2014:
24 NHS NHS ,639 organ donors 202 donors with history of cancer High risk cancers in 61 donors (133 recipients) breast:10, melanoma: 3, lymphoma: 5; colon: 3; ovary: 2; sarcoma: 4; CNS: 34 No transmission of cancer to the recipients Desai et al. Br J Surg, 2014:
25 Germany: MALORY study 248 organ donors, with 254 malignancies 702 organs transplanted to 648 recipients No transmission when the cancer was known before transplanta>on 7 cases of unknown cancer transmission Moench K, 24 th TTS, Berlin, Germany
26 LiRerature Breast cancer: - a few (<10 cases) reported case of transmission Prostate cancer - one reported case of transmission
27 2 categories Cadaveric donor with past history of non CNS cancer Cadaveric donor with past history of CNS cancer
28 Cadaveric donor with past history of CNS cancer According to several published guidelines & Council of Europe in 2011: - low grade tumour: OK for dona>on - high grade tumour: no dona>on - Higher risk if surgery, radiotherapy, VP shunt
29 UNOS ,340 deceased donors 397 deceased donors with history of CNS cancer 1,220 organs (293 livers) Mean follow- up: 36 months Kauffman et al. Transplanta>on 2002
30 UNOS ,340 deceased donors 397 deceased donors with history of CNS cancer 1,220 organs (293 livers) Mean follow- up: 36 months No transmission of cancer in the recipients! Kauffman et al. Transplanta>on 2002
31 UNOS ,340 deceased donors 397 deceased donors with history of CNS cancer only 19 with High grade Tumours 56 organs Mean follow- up: 36 months Kauffman et al. Transplanta>on 2002
32 UNOS TABLE 1. Deceased donor transplants from donors with a past history of cancer (n 1069), 2000 to 2005 Donor cancer type Deceased donor transplants Total Kidney Liver Heart Lung Heart lung Pancreas Kidney pancreas Skin (basal, squamous) Melanoma CNS: glioblastoma multiforme CNS: astrocytoma CNS: meningioma CNS: pituitary CNS: ependymoma CNS: oligodendroglioma CNS: other Uterine cervix Breast Prostate Uterine endometrial Bladder Ovarian Testicular Kidney Colorectal Thyroid Tongue/throat Lung Leukemia/lymphoma Other, specify Total
33 UNOS cases of transmissions of cancer to the recipients: - glioblastoma: kidney, liver, lung - melanoma: (32 years of follow- up) (unknown at the >me of procurement and transplanta>on) Kauffman et al. Transplanta>on 2007
34 UNOS ,314 Thoracic SOT 337 from donors with CNS malignancy hearts, 122 lungs, 3 heart- lungs 0 transmissions of CNS cancer in thoracic recipients Hynes et al. Clin Transplant 2017
35 Other series Australia & NZ: - 46 donors, 28 High grade, 153 organs, 27 livers Czech Republic: - 41 donors, 91 recipients UK: donors, 495 organs, 72 livers No transmission of cancer in the recipients!
36 Tumours in the donor:?????????
37 What is the risk? Unknown Overes>mated by publica>ons of case reports Liver, Lungs > kidney >heart
38 What is the risk? Donors with ac>ve non- CNS cancer: no Donors with ac>ve CNS cancer: yes Donors with past cancer? interval, tumor aggressiveness lymphoma, melanoma: no In which pa>ent? Donors with no history of cancer???
39 ATS 2013 Abstract#D1708 NHS ,765 organ transplants from 14,986 donors 15 donor- transmired cancer 6 renal K, 5 lungs, 2 lymphoma, 1 NET, 1 colon None of the donors were known to have cancer
40 Donor age Figure 4.2 Median age of deceased donors used for a transplant in Eurotransplant Eurotransplant annual report 2015
41 Donor age Figure 4.2 Median age of deceased donors used for a transplant in Eurotransplant Eurotransplant annual report 2015
42 Donor age Figure 4.2 Median age of deceased donors used for a transplant in Eurotransplant Eurotransplant annual report 2015
43
44 2 categories Cadaveric donor with past history of non CNS cancer Cadaveric donor with past history of CNS cancer
45 3 categories Cadaveric donor with past history of non CNS cancer Cadaveric donor with past history of CNS cancer Cadaveric donor with no history of cancer
46 hrps:// >ssues- cells- transplanta>on- guides html Guide to the quality and safety of ORGANS FOR TRANSPLANTATION European Committee (Partial Agreement) on Organ Transplantation (CD-P-TO ) EDQM 6 th Edition 2016
47 Thank you!
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