title: Transplantation of liver and kidney from donors with malignancy at the time of donation: an experience from a single centre.
abstract: Transplantation of organs from donors with malignancy poses clinical and ethical questions regarding outcome, informed consent, immunosuppression and follow-up. We review our experience of kidney and liver transplantation from such donors. Our database was complemented by data from National Health Service Blood and Transplant. All patients who received a renal or liver transplant in our institution between April 2003 and January 2014 were included. About 2546 liver and kidney transplants were performed: 71 recipients received 53 kidney and 18 liver transplants. These included 51 (36 kidney, 15 liver) CNS malignancy, and six kidneys, three ipsilateral and three contralateral with RCC. One kidney recipient developed donor-transmitted lung cancer in the transplant kidney, and one liver transplant recipient developed donor-transmitted lymphoma; both subsequently died. Seven recipients developed donor-unrelated cancer. No recipient developed cancer, whereas the donor had a CNS or RCC. The 1-, 3- and 5-year patient survival was 96%, 93.3% and 75%, respectively, for kidneys and 83.3%, 75% and 50%, respectively, for liver. Where donor malignancy was known and assessed before transplantation, judicious use of kidney and liver for transplant achieved satisfactory outcome. The risk of transmission from donors with CNS and low-grade renal malignancy remains extremely low.
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.|Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.
authors.forename: David
authors.initials: D
authors.lastname: Longbotham
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.
authors.forename: Lutz
authors.initials: L
authors.lastname: Hostert
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.
authors.forename: Magdy
authors.initials: M
authors.lastname: Attia
authors.affiliation: Department of Nephrology, St James's University Hospital, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.
authors.forename: Krishna
authors.initials: K
authors.lastname: Menon
authors.affiliation: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, UK.
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: CNS tumour; donor malignancy; kidney; liver; transplant