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1
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Jogendran M, Zhu K, Jogendran R, Sabrie N, Hussaini T, Yoshida EM, Chahal D. Incidence of luminal gastrointestinal cancers in patients with cirrhosis: A systematic review and meta-analysis. World J Meta-Anal 2025; 13:101187. [DOI: 10.13105/wjma.v13.i1.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 10/26/2024] [Accepted: 12/12/2024] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing. It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer. Such an association would have significant clinical implications, particularly for cancer screening prior to liver transplantation.
AIM To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.
METHODS An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis. Study-specific standardized incidence ratios (SIR) along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model. Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.
RESULTS We identified 5054 articles; 4 studies were selected for data extraction. The overall incidence of all cancers was significantly higher in patients with cirrhosis, with an SIR of 2.79 (95%CI: 2.18–3.57). When stratified by cirrhosis etiology, the incidence of luminal cancers remained significantly elevated for alcohol (SIR = 3.13, 95%CI: 2.24–4.39), Primary Biliary Cholangitis (SIR = 1.40, 95%CI: 1.10–1.79), and unspecified cirrhosis (SIR = 3.52, 95%CI: 1.87–6.65).
CONCLUSION The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis. Oral cavity, pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer. Therefore, increased screening of luminal cancers, and in particular these upper luminal tract subtypes, should be considered in this population.
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Affiliation(s)
- Manisha Jogendran
- Department of Medicine, Queens's University, Kingston K7L 2V7, ON, Canada
| | - Kai Zhu
- Department of Medicine, University of British Columbia, Vancouver 317-2194, BC, Canada
| | - Rohit Jogendran
- Department of Medicine, University of Toronto, Toronto 1 King's College Cir M5S 3H2, ON, Canada
| | - Nasruddin Sabrie
- Department of Medicine, University of Toronto, Toronto 1 King's College Cir M5S 3H2, ON, Canada
| | - Trana Hussaini
- BC Liver Transplant Program, Vancouver General Hospital, Vancouver V5Z 1M9, BC, Canada
| | - Eric M Yoshida
- Department of Gastroenterology, University of British Columbia, Vancouver V5Z 1M9, BC, Canada
| | - Daljeet Chahal
- Department of Gastroenterology, University of British Columbia, Vancouver V5Z 1M9, BC, Canada
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2
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Locatello LG, Caiazza N, Cavallo Ronchi F, Bergamin-Bracale AM, Miani C. Managing Thyroid Nodules in Brain-Dead Donors: Our Experience and a Review of the Literature. Head Neck 2025; 47:651-656. [PMID: 39370689 DOI: 10.1002/hed.27946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/31/2024] [Accepted: 09/18/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Thyroid nodules are common findings during the diagnostic work-up in potential organ donors. A fast yet thorough assessment to rule out cancer is mandatory but their management remains heterogeneous among hospitals and the evidence in this field is scarce. We present our institutional experience and review the most recent literature on this topic. METHODS Retrospective case series and systematic review of the literature. RESULTS In the years 2000-2023, 47 total thyroidectomies were performed on potential brain-dead donors. Intraoperative frozen section (FS) revealed 6 cases (13.9%) of papillary carcinoma that led to organ discarding in 3 cases (6.9%). The mean operative time of the procedures was 42.75 min and no procurement-delaying complications were registered. CONCLUSION Total thyroidectomy with an intraoperative FS is a sound method for assessing suspicious nodules before organ harvesting. Future randomized studies comparing its performance against fine needle aspiration biopsy are needed to define the most cost-effective and time-saving strategy.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria Della Misericordia," Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Nicole Caiazza
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria Della Misericordia," Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Federico Cavallo Ronchi
- Department of Otorhinolaryngology, Academic Hospital "Cattinara," Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Anna Maria Bergamin-Bracale
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria Della Misericordia," Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Cesare Miani
- Department of Otorhinolaryngology, Academic Hospital "Santa Maria Della Misericordia," Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
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3
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Turra V, Manzi J, Rombach S, Zaragoza S, Ferreira R, Guerra G, Conzen K, Nydam T, Livingstone A, Vianna R, Abreu P. Donors With Previous Malignancy: When Is It Safe to Proceed With Organ Transplantation? Transpl Int 2025; 38:13716. [PMID: 39926359 PMCID: PMC11802283 DOI: 10.3389/ti.2025.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/07/2025] [Indexed: 02/11/2025]
Abstract
The growing number of organ donors in the United States, from 14,011 in 2012 to 21,374 in 2022, highlights progress in addressing the critical issue of organ shortages. However, the demand remains high, with 17 patients dying daily while on the waiting list. As of August 2023, over 103,544 individuals are awaiting transplants, predominantly for kidneys (85.7%). To expand the donor pool, the inclusion of elderly donors, including those with a history of malignancies, is increasingly considered. In 2022, 7% of all donors were aged 65 and above, despite the complexities their medical histories may introduce, particularly the risk of donor-transmitted cancer (DTC). This review examines the challenges and potential benefits of using donors with known malignancy histories, balancing the risks of DTC against the urgency for transplants. A critical analysis is presented on current knowledge and the decision-making processes that consider cancer types, stages, and patient survival outcomes. The goal is to identify missed opportunities and improve strategies for safe and effective organ transplantation from this donor demographic.
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Affiliation(s)
- Vitor Turra
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Joao Manzi
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Sarah Rombach
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Simone Zaragoza
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Raphaella Ferreira
- HCA Healthcare–HealthOne Internal Medicine Residency Program, Sky Ridge Medical Center, Denver, CO, United States
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Kendra Conzen
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trevor Nydam
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alan Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Rodrigo Vianna
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Phillipe Abreu
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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4
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Sesa V, Silovski H, Basic-Jukic N, Kosuta I, Sremac M, Mrzljak A. Genitourinary tumors and liver transplantation: A comprehensive review. World J Transplant 2024; 14:95987. [PMID: 39295969 PMCID: PMC11317849 DOI: 10.5500/wjt.v14.i3.95987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 07/31/2024] Open
Abstract
Liver transplantation is as a crucial therapeutic option for patients with end-stage liver disease, but the persistent organ shortage emphasizes a need to explore unconventional donor sources, including individuals with a history of malignancies. This review investigates the viability of liver donation from individuals with current or past genitourinary malignancies, focusing on renal, prostate and urinary bladder cancers. The rising incidence of urogenital malignancies among potential donors is thought to result from increasing donor age. Analysis of transmission risks reveals low rates of donor-derived cancer transmission, particularly for early-stage renal and prostate cancers. Recipients with a history of genitourinary malignancy pose complex challenges regarding post-transplant immunosuppression and cancer recurrence. Nonetheless, the evidence suggests acceptable outcomes can be achieved with careful patient selection and tailored management strategies. Recommendations for pre-transplant evaluation and post-transplant surveillance are discussed, highlighting the need for individualized approaches in this patient population. Further prospective studies are warranted to refine guidelines and optimize outcomes in liver transplantation for patients with genitourinary malignancies.
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Affiliation(s)
- Vibor Sesa
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Hrvoje Silovski
- Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Nikolina Basic-Jukic
- Department of Medicine, School of Medicine, Zagreb 10000, Croatia
- Department of Nephrology, Arterial hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Iva Kosuta
- Department of Intensive Care Medicine, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Maja Sremac
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- Department of Medicine, School of Medicine, Zagreb 10000, Croatia
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5
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González IA, Saeed O, Mustafa M, Segura SE, Collins K, Hou T, Mesa H, Lee SM, Zhang D, Lin J, Cummings OW. Incidental findings during donor liver assessment: Single center experience. Ann Diagn Pathol 2024; 69:152266. [PMID: 38266545 DOI: 10.1016/j.anndiagpath.2024.152266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Intraoperative consultation of donor liver is an important part of transplant evaluation and determination of liver eligibility. In this study, we describe incidental pathologic findings discovered during the pretransplant evaluation of liver donors in our Institution from 1/2010 to 12/2022. During this 13-year period 369 intraoperative consultations from 262 liver donors were performed. Of those cases, incidental findings were identified in 22 cases (5.9 %) from 19 donors (7.3 %); two donors had more than one lesion. The median age of this subset of patients was 53 years (range: 18-70) and females predominated (63 %). Sixteen of the donors had abnormal findings in the liver: 6 bile duct hamartoma (BDH), 5 hyalinized nodule with Histoplasma capsulatum, 5 focal nodular hyperplasia (FNH), 2 bile duct adenomas (BDA), 1 biliary cyst and 1 hemangioma. One donor had both FNH and a BDH. One BDH and 1 BDA case was misdiagnosed as malignancy during the frozen section evaluation. Three donors had extrahepatic pathologies: a pancreatic tail schwannoma, a low-grade appendiceal mucinous neoplasm, and a lymph node with metastatic endometrial endometrioid adenocarcinoma. Of the 19 livers, the final organ disposition was available for 9: 6 were transplanted (67 %) and 3 were discarded (33 %). Two of the 3 discarded organs were misdiagnosed BDH and BDA cases, and one was incorrectly reported as having 90 % microvesicular steatosis during the frozen assessment. We present the clinicopathologic characteristics of liver donors with incidental findings during the pre-transplant evaluation which could lead to unwarranted graft dismissal if misdiagnosed. Additionally, incidental fungal infections can have implications for immunosuppressive therapy and the decision to use or reject the graft.
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Affiliation(s)
- Iván A González
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America.
| | - Omer Saeed
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Mohamed Mustafa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Sheila E Segura
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Katrina Collins
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Tieying Hou
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Hector Mesa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Sun M Lee
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Oscar W Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
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6
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Malvi D, Vasuri F, Albertini E, Carbone M, Novelli L, Mescoli C, Cardillo M, Pagni F, D'Errico A, Eccher A. Donors risk assessment in transplantation: From the guidelines to their real-world application. Pathol Res Pract 2024; 255:155210. [PMID: 38422913 DOI: 10.1016/j.prp.2024.155210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Transplantation of an organ from a donor carries an unavoidable risk of tumor transmission. The need to extend the donor pool increases the use of organs from donors with malignancies and potential disease transmission is a constant tension influencing donor suitability decisions. Current classification systems for the assessment of donor malignancy transmission risk have evolved from reports of potential transmission events in recipients to national donation and transplant surveillance agencies. Although the risk of malignancy transmission is very low in the general transplant setting it must constantly be balanced with the transplant benefits. Guidelines are mainly based on large registries and sparse case reports of transmission, so they cannot cover all the possible situations. For this reason, in 2004 in Italy, the National Transplant Center gave rise to the Second Opinion Service, charged by the Ministry of Health, by structuring expertise in diagnostic oncology and risk transmission and making it available to the Italian Transplant Centers. In this paper the registry of the Italian Oncological Second Opinion was reviewed, from 2016 to 2018, to detail the most frequent and problematic neoplastic topics addressed, those are separately reported and discussed. Furthermore, a review of the most recent strategies and risk stratification is provided, according to the most recent literature evidence and to the European Guidelines.
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Affiliation(s)
- Deborah Malvi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elisa Albertini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maurizio Carbone
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, Italy
| | - Massimo Cardillo
- Italian National Transplantation Center, Italian National Institute of Health, Rome, Italy
| | - Fabio Pagni
- University Milan Bicocca, Department of Medicine and Surgery, Departmental Center of Digital Medicine, Milan, Italy
| | - Antonia D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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7
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Puri P, Kumar A, Qaleem M. Donor Evaluation Protocol for Live and Deceased Donors. J Clin Exp Hepatol 2024; 14:101217. [PMID: 38076356 PMCID: PMC10709134 DOI: 10.1016/j.jceh.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/09/2023] [Indexed: 01/05/2025] Open
Abstract
Donor evaluation is a critical step before proceeding with liver transplantation (LT) in both deceased donor LT (DDLT) and living donor LT (LDLT). A good, healthy graft is necessary for the success of the transplantation. Other issues in selecting a donor include the transmission of infections and malignancies from the donor. Because of the scarcity of cadaver organs, an increasing number of extended-criteria donors, or 'marginal donors', are being utilized. LDLT also has potential risks to the donor, and donor safety needs to be kept in mind before proceeding with LT. The current review highlights the factors to be considered during donor evaluation for living and deceased donors before LT.
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Affiliation(s)
- Pankaj Puri
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Abhinav Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Mohd Qaleem
- Department of Liver Transplantation, Minimal Access & GI Surgery, Fortis Escorts Hospital, New Delhi-110025, India
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8
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Eccher A, Pagni F, Marletta S, Munari E, Dei Tos AP. Perspective of a Pathologist on Benchmark Strategies for Artificial Intelligence Development in Organ Transplantation. Crit Rev Oncog 2023; 28:1-6. [PMID: 37968987 DOI: 10.1615/critrevoncog.2023048797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Transplant pathology of donors is a highly specialized field comprising both the evaluation of organ donor biopsy for the oncological risk transmission and to guide the organ allocation. Timing is critical in transplant procurement since organs must be recovered as soon as possible to ensure the best possible outcome for the recipient. To all this is added the fact that the evaluation of a donor causes difficulties in many cases and the impact of these assessments is paramount, considering the possible recovery of organs that would have been erroneously discarded or, conversely, the possibly correct discarding of donors with unacceptable risk profiles. In transplant pathology histology is still the gold standard for diagnosis dictating the subsequent decisions and course of clinical care. Digital pathology has played an important role in accelerating healthcare progression and nowadays artificial intelligence powered computational pathology can effectively improve diagnostic needs, supporting the quality and safety of the process. Mapping the shape of the journey would suggest a progressive approach from supervised to semi/unsupervised models, which would involve training these models directly for clinical endpoints. In machine learning, this generally delivers better performance, compensating for a potential lack in interpretability. With planning and enough confidence in the performance of learning-based methods from digital pathology and artificial intelligence, there is great potential to augment the diagnostic quality and correlation with clinical endpoints. This may improve the donor pool and vastly reduce diagnostic and prognostic errors that are known but currently are unavoidable in transplant donor pathology.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Stefano Marletta
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy; Division of Pathology Humanitas Cancer Center, Catania, Italy
| | - Enrico Munari
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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9
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Lapointe M, Kerbaul F, Meckert F, Cognard N, Mathelin C, Lodi M. [Breast cancer and organ transplantation: Systematic review and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:60-72. [PMID: 36375787 DOI: 10.1016/j.gofs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Affiliation(s)
- M Lapointe
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - F Kerbaul
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - F Meckert
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - N Cognard
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
| | - M Lodi
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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10
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Domínguez-Gil B, Moench K, Watson C, Serrano MT, Hibi T, Asencio JM, Van Rosmalen M, Detry O, Heimbach J, Durand F. Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference. Transplantation 2022; 106:e12-e29. [PMID: 34905759 DOI: 10.1097/tp.0000000000003995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to have a current or past history of malignancy. The frequency of DTCs is consistently reported at 3-6 cases per 10 000 solid organ transplants, with a similar frequency in the LT setting. A majority of DTCs are occult cancers unknown in the donor at the time of transplantation. Most DTCs are diagnosed within 2 y after LT and are associated with a 51% probability of survival at 2 y following diagnosis. The probability of death is greatest for DTCs that have already metastasized at the time of diagnosis. The International Liver Transplantation Society-Sociedad Española de Trasplante Hepático working group on DTC has provided guidance on how to minimize the occurrence of DTCs while avoiding the unnecessary loss of livers for transplantation both in deceased and living donor LT. The group endorses the Council of Europe classification of risk of transmission of cancer from donor to recipient (minimal, low to intermediate, high, and unacceptable), classifies a range of malignancies in the liver donor into these 4 categories, and recommends when to consider LT, mindful of the risk of DTCs, and the clinical condition of patients on the waiting list. We further provide recommendations to professionals who identify DTC events, stressing the need to immediately alert all stakeholders concerned, so a coordinated investigation and management can be initiated; decisions on retransplantation should be made on a case-by-case basis with a multidisciplinary approach.
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Affiliation(s)
| | - Kerstin Moench
- Donor Transplant Coordination Unit, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Christopher Watson
- The Roy Calne Transplant Unit and Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - M Trinidad Serrano
- Hepatology Section, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - José M Asencio
- Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | | | - François Durand
- Hepatology Department, Liver Intensive Care Unit, Hospital Beaujon, Clichy, France
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11
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Abaalkhail FA, Al Sebayel MI, Shagrani MA, O’Hali WA, Almasri NM, Alalwan AA, Alghamdi MY, Al-Bahili H, AlQahtani MS, Alabbad SI, Al-Hamoudi WK, Alqahtani SA. Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia. Saudi Med J 2021; 42:927-968. [PMID: 34470833 PMCID: PMC9280503 DOI: 10.15537/smj.2021.42.9.20210126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022] Open
Abstract
The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country's high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a significantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.
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Affiliation(s)
- Faisal A. Abaalkhail
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Mohammed I. Al Sebayel
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Mohammed A. Shagrani
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Wael A. O’Hali
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Nasser M. Almasri
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Abduljaleel A. Alalwan
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Mohammed Y. Alghamdi
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Hamad Al-Bahili
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Mohammed S. AlQahtani
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Saleh I. Alabbad
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Waleed K. Al-Hamoudi
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
| | - Saleh A. Alqahtani
- From the Department of Medicine (Abaalkhail), Gastroenterology Section, from the Organ Transplant Center (Shagrani, Alabbad, Al-hamoudi, Alqahtani S), King Faisal Specialist Hospital & Research Center; from the College of Medicine (Abaalkhail, Shagrani,) Alfaisal University; from the Department of Surgery (Al Sebayel), Almaarefah University; from the Hepatobiliary Sciences and Organ Transplant Center (O’Hali, Alalwan), King Abdulaziz Medical City; from the Department of Medicine (Almasri), Multiorgan Transplant Center (Al-Bahili), Prince Sultan Medical Military City; from the Liver Research Center (Al-hamoudi), King Saud University, Riyadh; from the Department of Medicine (Alghamdi), King Fahd Military Medical Complex, Dahran; from the Multi-Organ Transplant Center (Alqahtani M), King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia; and from the Johns Hopkins University (Alqahtani S), Baltimore, MD, United States of America.
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Eccher A, Girolami I, Marletta S, Brunelli M, Carraro A, Montin U, Boggi U, Mescoli C, Novelli L, Malvi D, Lombardini L, Cardillo M, Neil D, D'Errico A. Donor-Transmitted Cancers in Transplanted Livers: Analysis of Clinical Outcomes. Liver Transpl 2021; 27:55-66. [PMID: 32746498 DOI: 10.1002/lt.25858] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
The risk of transmission of malignancy from donor to recipient is low. However, this occurrence has dramatic consequences. Many reports of donor-derived cancers in liver transplant recipients have been published, but they have not been systematically summarized into a lucid and unified analysis. The present study is an attempt to provide clarity to this unusual but clinically important problem. We systematically reviewed all patient reports, patient series, and registries published on cancer transmission events through the end of December 2019. We identified a total of 67 publications with 92 transmission events. The most frequently transmitted cancers were lymphomas (30; 32.6%), melanomas (8; 8.7%), and neuroendocrine tumors (8; 8.7%). Most of the melanomas were metastasizing, whereas most of the lymphomas were localized to the graft. The median time to cancer diagnosis after transplantation was 7 months, with 78.1% of diagnoses established in the first year. Melanoma carried the worst prognosis, with no recipients alive at 1 year after cancer diagnosis. Lymphoma recipients had a better outcome, with more than 75% surviving at 2 years. A metastatic cancer carries a worse prognosis for recipients, and recipients with localized cancer can benefit from the chance to undergo transplantation again. The findings confirm the need to pay attention to donors with a history of melanoma but also suggest the need for a more careful evaluation of groups of donors, such as those dying from cerebral hemorrhage. Finally, recipients of organs from donors with cancer should be carefully followed to detect potential transmission.
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Affiliation(s)
- Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Amedeo Carraro
- General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Umberto Montin
- General Surgery Unit, ULSS1 Dolomiti Hospital of Feltre, Feltre, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Claudia Mescoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University and Hospital Trust of Padua, Padua, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Deborah Malvi
- Pathology Unit, Sant'Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - Letizia Lombardini
- National Health Institute, Rome, Italy.,National Transplant Center, Rome, Italy
| | | | - Desley Neil
- University Hospital Birmingham, Birmingham, United Kingdom
| | - Antonietta D'Errico
- Pathology Unit, Sant'Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
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13
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Wu JH, Qiao PF, Sun XY, Dong JH, Liao JX, Liu XY, Gao Z, Lan LG, Li HB, Su QD. Evaluation and application of donors with primary central nervous system tumors. Clin Transplant 2019; 33:e13677. [PMID: 31342552 DOI: 10.1111/ctr.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to explore the safety of donors with primary central nervous system tumors for kidney and liver transplantations. METHODOLOGY Clinical data of 29 donors with primary CNS tumors in January 2007 to December 2017, as well as the follow-up data of 16 liver transplant recipients and 46 kidney transplant recipients, were analyzed. According to the risk factors, the high-risk group was classified as Group 1, the low-risk factors were classified as Group 2, and the unknown risk group was classified as Group 3. The incidence of donor-transmitted CNS tumors was calculated and compared. RESULTS The duration from the diagnosis of 29 donors to donation was 5.67 ± 6.36 months. None of the liver and kidney transplant recipients who were followed up had tumor metastasis. Although the mean survival time of Group 1 was lower than that of Group 2 and Group 3, the Kaplan-Meier curve showed no significant difference in survival time. CONCLUSION No obvious difference was observed between high-risk and low-risk and unknown risk CNS tumors in terms of the survival rate of transplants and tumor metastasis rate. High-risk CNS tumor donors can be used with the informed consent of recipients after a full evaluation.
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Affiliation(s)
- Ji-Hua Wu
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China.,Organ Transplantation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Peng-Fei Qiao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Xu-Yong Sun
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China.,Organ Transplantation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jian-Hui Dong
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Ji-Xiang Liao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Xu-Yang Liu
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Zhao Gao
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Liu-Gen Lan
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Hai-Bin Li
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
| | - Qing-Dong Su
- Institute of Transplant Medicine, No. 923 Hospital of Chinese People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Nanning, Guangxi, China
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Sakuraoka Y, da Silva Boteon APC, Brown R, Perera MTPR. Severe atherosclerosis of donor hepatic arteries is a salvageable condition in liver transplantation to optimise the graft utilisation: A case series and review of the literature. Int J Surg Case Rep 2019; 59:190-196. [PMID: 31176087 PMCID: PMC6556552 DOI: 10.1016/j.ijscr.2019.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022] Open
Abstract
We showed how to manage sever atherosclerosis in liver transplant with special technique. This case report will help not to discard donated liver graft. Management of sever artherosclerosis, liver transplantation. Introduction The presence of atherosclerosis of the common hepatic artery (CHA) in donor livers potentially contributes to vascular complications after liver transplantation, thereby most of those organs are traditionally discarded. Herein, we describe the successful outcome of three patients transplanted with grafts that had severe atherosclerosis of the donor CHA up to the level of the gastroduodenal artery (GDA). Presentation of case In all three cases, endarterectomies were performed by dissection between the atheromatous core and the artery intima using a dissecting spatula, allowing to secure the lumen of the vessel. The native CHA/GDA patch was aligned with the corresponding CHA/GDA patch from the graft for the arterial reconstruction. No vascular complications were seen post-operatively. Discussion Endarterectomy and anatomical reconstitution of the arterial tree, without any redundancy or kinking, allowed for the successful transplantation of organs that would be otherwise discarded. Further, the straight alignment of the arteries may enhance flow dynamics, preventing thrombosis. Conclusion This report might guide future studies targeting means to increase the utility of donor livers discarded due to arterial atherosclerosis.
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Affiliation(s)
- Yuhki Sakuraoka
- Second Department of Surgery, Dokkyo Medical University, Japan; The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom.
| | | | - Rachel Brown
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - M Thamara P R Perera
- The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom
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15
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How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J Nephrol 2019; 32:323-330. [PMID: 30604151 DOI: 10.1007/s40620-018-00573-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023]
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