Donor transmitted and de novo cancer after liver transplantation

Table 1 Published cases of donor transmitted cancer among liver allograft recipients

Cancer type	Donor’s cause of death	Cancer known in donor	Recipient outcome and cause of death	Ref.
Choriocarcinoma	Cerebral haemorrhage	Identified on autopsy	Death due to DTC	[52]
	Cerebral haemorrhage	Identified in the placenta	Death due to DTC	[53]
	NS	No	Death due to DTC	[54]
	Cerebral haemorrhage	Diagnosed retrospectively by testing the stored serum	Death due to DTC	[55]
	Cerebral haemorrhage	No	Death due to DTC	[56]
Colon	Cerebrovascular event	No	Death due to DTC	[57]
	Cerebrovascular event	No	Death due to DTC, despite re-transplant	[13]
	Cerebral haemorrhage	No	Death due to DTC	[58]
CNS-astrocytoma	Astrocytoma	Yes	Death due to DTC	[59]
CNS-glioma, GBM	GBM	Yes	Death due to liver failure	[60]
	GBM	Yes	Death due to DTC	[61]
	Malignant glioma	Yes	Death due to DTC	[62]
CNS-pinealoblastoma	Pinealoblastoma	Yes	Death due to DTC	[63]
Kaposi’s sarcoma	NS	NS	Death due to DTC	[54]
Lymphoma	Suspected meningitis	Diagnosed after donation	Death due to DTC	[64]
Melanoma	Cerebral haemorrhage	No	Death due to DTC	[24]
	Cerebral haemorrhage	No	Death due to DTC	[65]
	Sub-arachnoid haemorrhage	No	Death due to DTC	[66]
	Cerebral haemorrhage	No	Death due to DTC	[67]
	NS	No	Death due to DTC	[68]
Neuroendocrine cancer	Sub-arachnoid bleed	No	Death due to DTC	[69]
	Cerebrovascular event	No	Death due to DTC	[70]
	NS	No	Alive on chemotherapy	[71]
Ovary	Anoxic brain injury	No	Death due to DTC	[15]
Pancreas	Cerebral haemorrhage	No	Alive at 1 yr following urgent re-transplant	[72]
Sarcoma	Asthma	No	NS	[73]
Unspecified adenocarcinoma	NS	NS	Alive at 8 mo following re-transplantation	[74]
Unspecified squamous carcinoma	Cerebral haemorrhage	No	Alive at 30 mo following re-transplantation	[75]
Urothelium	Sub-arachnoid haemorrhage	No	Alive at 4 yr following re-transplantation	[76]
	Sub-arachnoid haemorrhage	No	NS	[77]

NS: Not specified; DTC: Donor transmitted cancer; CNS: Central nervous system; GBM: Glioblastoma multiforme.

Table 2 Summary of council of europe and organ procurement and transplantation network/united network for organ sharing guidelines for donor with cancer history

Council of Europe guidelines[17]: Donors with unacceptable risk of transmission
Features applicable to cancer of any histological type at any time prior to donation
Presence of metastasis - lymphatic or distant
Absence of curative surgical treatment or missed follow-up (except low-grade prostate cancer under surveillance)
Palliative therapy for cancer
Non-CNS cancer at any time prior to donation
Breast
Ovary
Choriocarcinoma
Malignant melanoma, including carcinoma-in-situ
Sarcoma
Chronic Leukaemia
Thyroid (except capsulated papillary or minimally invasive follicular type)
Non-CNS cancer diagnosed during donor procurement
All cancers, except:
Renal cell cancer < 2.5-4.0 cm (pT1a), tumour free resection margin and Fuhrman grade I or II
Localised low grade (Gleason score ≤ 6) prostate cancer
Small gastrointestinal stromal tumours
Localised non-melanoma skin cancer
Cancers of the CNS
WHO grade IV cancers
WHO grade III cancers with following features:
Presence of ventriculo-peritoneal or ventriculo-atrial shunts
Craniotomy
Systemic chemotherapy
Radiotherapy
OPTN/UNOS guidelines[18] - intermediate or high risk of transmission
Intermediate risk of transmission (1%-10%) Breast cancer, stage 0 Colon cancer, stage 0 Renal cell cancer (resected, solitary): 4-7 cm, well differentiated, stage I Treated non-CNS malignancy (≥ 5 yr prior) with cure rate 90%-99%	High risk of transmission (> 10%) Breast cancer, stage > 0 Colon cancer, stage > 0 Renal cell cancer: > 7 cm or stage II-IV Choriocarcinoma Leukaemia Lymphoma Small cell cancer: lung/neuroendocrine Metastatic carcinoma Sarcoma Lung cancer: stage I-IV Any CNS tumour with ventriculo-peritoneal or ventriculo-atrial shunt, surgery (other than uncomplicated biopsy), irradiation or extra-cranial metastases CNS tumour of WHO grade III or IV Any other cancer with insufficient follow-up or probability of cure < 90%

OPTN/UNOS: Organ Procurement and Transplantation Network/United Network for Organ Sharing Guidelines; CNS: Central nervous system; WHO: World health organization.

Table 3 Increased risk of cancer after liver transplantation compared with general population adjusted for age, gender and year

Cancer type	Standardised incidence ratio
All cancers	2-3
Kaposi’s sarcoma	37-144
Non-melanoma skin cancer	6-38
Lip	20
Lymphoma	7-13
Upper aero-digestive tract	10-15
Anus	3-10
Kidney	2-4
Colorectal (PSC-IBD)	3
Melanoma, lung	2
Colorectal (non PSC-IBD)	Not increased
Myeloma	Not increased
Breast	Not increased
Prostate	Not increased

PSC-IBD: Primary sclerosing cholangitis inflammatory bowel disease.