title: Cancer transmission from organ donors-unavoidable but low risk.
abstract: BACKGROUND
  Donor origin cancer (DOC) in transplant recipients may be transmitted with the graft (donor-transmitted cancer [DTC]) or develop subsequently from the graft (donor-derived cancer [DDC]).
  
  
  METHODS
  Recipients with DOC between January 1, 2001, and December 31, 2010, were identified from the United Kingdom Transplant Registry and database search at transplantation centers.
  
  
  RESULTS
  Of 30,765 transplants from 14,986 donors, 18 recipients developed DOC from 16 donors (0.06%): 3 were DDC (0.01%) and 15 were DTC (0.05%). Of the 15 DTCs, 6 were renal cell cancer; 5, lung cancer; 2, lymphoma; 1, neuroendocrine cancer; and 1, colon cancer. Recipients with DTC underwent explant/excision (11), chemotherapy (4), and radiotherapy (1). Of 15 recipients, 3 (20%) recipients with DTC died as a direct consequence of cancer. Early DTC (diagnosed ≤6 weeks of transplantation) showed a better outcome (no DTC-related deaths in 11 cases) as opposed to late DTC (DTC-related deaths in 3 of 4 cases). Five-year survival was 83% for kidney recipients with DTC compared with 93% for recipients without DTC (P=0.077). None of the donors resulting in cancer transmission was known to have cancer at donation.
  
  
  CONCLUSIONS
  DTC is rare but frequently results in graft loss and death. The risk of cancer transmission cannot be eliminated because, in every case, the presence of cancer was not known at donation. This information will allow informed consent for prospective recipients. Explantation/excision is likely to benefit recipients with localized cancer, but in transplants other than kidney/pancreas, the benefits should be balanced against the risks of retransplantation.
authors.affiliation: National Health Service Blood and Transplant, Bristol, United Kingdom. rajeev.desai@nhs.net
authors.forename: Rajeev
authors.initials: R
authors.lastname: Desai
authors.forename: Dave
authors.initials: D
authors.lastname: Collett
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Watson
authors.forename: Philip
authors.initials: P
authors.lastname: Johnson
authors.forename: Tim
authors.initials: T
authors.lastname: Evans
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000209:etiology / Q000401:mortality; D002295:Carcinoma, Transitional Cell / Q000209:etiology / Q000401:mortality; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000209:etiology / Q000401:mortality; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D008223:Lymphoma / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000401:mortality*; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology