Donors with primary intracranial malignancy, has the risk of spread outside the CNS, and hence the risk to transplant recipients is small. Organs from Donors with primary intracranial malignancy have been used for transplantation over many years as the risk of getting malignancy is considered none.
A reliable estimate of the true risk of transmission of an intracranial malignancy is necessary to enable a balanced decision to be made regarding the risks to potential recipients.
The Study between 1985 and 2001 aimed to quantify the risk of transmission of a primary intracranial malignancy from Donors with primary intracranial malignancy. The study data was from the UK Transplant Registry and from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors.
UK cancer registries have estimated completeness of registration to be 94% for all malignancies excluding nonmelanoma skin cancer
All recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006, giving a minimum follow-up period of 5 years for all transplant recipients.
The study showed identified 177 of these donors from a total of 448 recipients of 495 organs in which no transmission of donor intracranial malignancy occurred. Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers. The most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumours, should be considered for transplantation and the small risk of tumour transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Study limitation was cancer registries did not record complete data on the treatment of intracranial tumours. Data were not available on the mode of diagnosis of the tumour (biopsy, craniotomy, or autopsy) or only based on the appearance on imaging in the absence of histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumours should not be used because of the perceived high risk of cancer transmission.
The patient should be counselled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting
Amna Khalifa
2 years ago
Introduction
Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients. Exception is use of organs from donors with primary intracranial malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low.
Council of Europe in 1997 stated that while the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
In this study data held on the UK Transplant Registry on transplant recipients and organ donors together with information on new cancers held by the UK national cancer registries is reviewed. Method
· Retrospective study using data from The UK Transplant Registry
· between 1985 and 2001 including data related to their cancer registry were reviewed.
· From 8 regional cancer registries in England, Northern Ireland, Wales and Scotland, and all record the occurrence and type of every primary malignancy upon diagnosis.
· 179 donors with intracranial malignancy donates organs for 526 recipients and 448 Recipients traceable by cancer registries. Discussion and conclusion
Donors with intracranial malignancies should be assessed by the surgeons carfully before accepting them . histology and treatment received should be part of important information to get. risk of transmission is higher if patient (donor) undergone interventions such as stereotactic biopsy , debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier.
amiri elaf
2 years ago
How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data Please provide a summary of this article
The objective:
*This analysis to quantify the risk of transmission of a primary intracranial cancer from an organ donor, by studying the incidence of transplanted patients in the UK.
Introduction:
*Transmission of donor-related malignancy by organ transplantation is associated with a lethal outcome in immunosuppressed transplant patient.
*Organs from potential donors who have active or new managed cancer are not considered suitable for transplantation, even when there is no evidence of metastasis; however, organs from donors with primary intracranial malignancy has low risk of transmission. *Council of Europe in 1997 conducted that the use of organs from donors with low-grade primary malignancy was safe,however, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
*Recent analysis from the United States conducted that the rate of disease transmission might be significantly below than previously thought.
*The shortage of donor organs available for transplantation is such that the risks of disease transmission by organs from a donor with primary CNS malignancy have to be balanced carefully against the risk of a potential recipient remaining on the waiting list for transplantation.
The method:
*Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales
and Northern Ireland to identify all organ donors between
1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
The result:
*Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
*A total of 448 recipients of 495 organs from 177 of these donorswere identified.No transmissions of donor intracranial malignancy occurred.
* Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Hamdy Hegazy
2 years ago
Please provide a summary of this article Donors with active or recently treated malignancy are declined for donation. However, primary intra-cranial malignancy risk of metastasis outside the CNS is low, so they can be accepted for donation under certain circumstances.
In 1997, the European council stated that organs from donors with high grade malignant CNS tumours especially when the blood brain barrier integrity is compromised should not be considered safe for transplantation.
This is a retrospective study. Data was collected from the UK transplant registry and from the UK national cancer registries.
Aim: assess the transmission risk of primary intra-cranial malignancy from donors’ organs to the recipients.
Study population: 11799 donors from The UK national transplant registry. 179 donors identified with IC malignancy and transplanted to 582 recipients (325 kidneys, 101 livers, 76 hearts, 71 lungs, 9 pancreas).
Results, discussion and recommendations:
None of 177 donors with primary IC malignancy (23 grade IV GA glioblastoma, 9 grade IV medulloblastoma) transmitted the disease to the 448 recipients receiving their organs. the guidelines should not be taken separately, so the risk of IC malignancy transmission should be balanced against the risk of recipient death while on the waiting list. In presence of low number of available organs for donation and long waiting list, using organs from donors with primary IC malignancy should be considered.
These results should stress on the co-ordination between organ retrieval surgeons and surgeons transplanting organs to recipients from the same donor whenever a suspicious lesion is identified to allow decision regarding proceeding or not. risk factors of IC malignancy spread include: Craniotomy, ventriculo-peritoneal shunts, previous radiotherapy or chemotherapy and longer time between diagnosis and death.
on organ retrieval, proper examination and assessment of organs to rule out any metastasis.Pre-transplantation counselling is of utmost importance discussing pros and cons of proceeding with this donation offer.
Amit Sharma
2 years ago
Please provide a summary of this article
This retrospective study involved assessment of national cancer registry data of England, Wales and Northern Ireland, and UK transplant registry data with respect to organ donation from patients dying of intracranial malignancies and risks of tumor transmission form the donor to recipient. The data from 1985 to 2001 was collected and occurrence of recipient cancers was recorded till 2006 (with a minimum of 5 years follow-up).
Out of 5934 donors with linkage to the cancer registries, 227 donors had invasive cancers, out of which 179 had intracranial malignancies. 526 recipients received organs from the 179 donors, out of which 448 were traceable by cancer registries.
32 donors with high grade CNS tumors provided organs to 85 recipients.
None of the recipient developed intracranial malignancy. Only 10 recipients developed non-skin invasive malignancy, with PTLD in 4 of them.
Australia and New Zealand registry showed no transmission while the UNOS data showed that the risk of GBM transmission form donor to recipient is very low (1.7%). The Israel Penn International Transplant Tumor registry (IPITTR), on the other hand showed increased risk of transmission (30-40%). The risk factors for spread include ventriculo-systemic shunts, prior radiotherapy or chemotherapy, increased time between tumor diagnosis and death, stereotactic biopsy, craniotomy and major resection.
The results of the study reassured that the risk of transmission of primary CNS neoplasm from donor to recipient is very low (including for high-grade tumors), and the risk of transmission should be balanced against the risk of dying on dialysis in absence of receiving a transplant. The prospective recipient should be counselled accordingly.
Limitations of the study: Retrospective study, data regarding time of histological diagnosis (whether before transplant, or after transplant) not available, lack of criteria for diagnosing the tumor, and lack of data regarding death while awaiting transplant versus death due to malignancy transmitted from a donor.
This retrospective study analyzed the different tumors and rate of transmission from patients in countries( UK registry).
It has included all organ Tx from 1985 to 2001 having primary intracranial tumor and its transmission to recipient. there is conflicting report across the registry, there is small absolute risk of primary CNS malignancy in the recipient with other organ from donor with high rate of malignancy. According to Council of European guidelines organ from donors with high -grade tumors should not be used because of the risk of tumor transmission.
Balaji Kirushnan
2 years ago
Brain death due to potential intracranial malignancy represents an important source of organs from donors after brain death….However there is a perceived risk of cancer transmission after the organ donation which is not clear …..
this study reviewed the list of tumor transmission from patients in the United Kingdom, Ireland, south wales.. they included all organ transplant recipients between 1985 and 2001 with inclusive of primary intracranial malignancy and studied the occurrence of post transplant malignancy in the recipient…
Transmission of donor related malignancy is a well known entity and transmission of malignancy from the donor to the recipient always has been a concern….Infact Donors with active malignancy are contraindicated from organ donation… The only exception to this rule is primary intracranial malignancy where the disease spread outside the CNS is very rare…Low grade tumors are not associated with disease spread whereas high grade gliomas where the integrity of the blood brain barrier is compromised was associated with donor cancer transmission….An advice from the council of Europe in 1997 showed that low grade primary brain tumors are safe for organ donation after Brian death and to avoid organ donation from high grade blastomas…This study was undertaken to quantify the risk and create awareness among more brain death organ donation among Primary CNS malignancy
179 patients had intra cranial cancer from which 582 organs were transplanted into 562 recipients….448 recipients could have their data analyzed and were published…No record on recipient intra cranial malignancies were seen from donor primary intracranial malignancy….10 patients had developed non skin malignancies after transplant and it included the most common post transplant lymphoproliferative disease with non Hodgkin’s lymphoma being the commonest…
This data from UK registry which was a retrospective analysis showed that organ donation from the donors who had even high grade glioblastomas or medulloblastoma also did not have increased rate of intracranial malignancy transmission….This finding was new as compared to older case reports of breach in the blood brain barrier with high grade tumors….
this data is in contrast to the Israel Transplant Penn Registry which report 40% donor transmission of glioblastoma multiforme and Grade III glioma transmission of 30%…
Given the conflicting reports across the registry, It is suggested that there is a small absolute risk of Primary CNS malignancy in the recipient with organs from donors with high grade malignancy…an informed consent should be taken to the recipients and if they accept we can go ahead rather than waiting eternally on hemodialysis….A knowledge of the tumor histology, the details of the chemotherapy and radiotherapy, role of stereotactic biopsy, inspection for peritoneal metastasis and epineural invasion of spinal cord will help us to decide, if the organ needs to be harvested…We should avoid organs from these advanced tumors as the spread rate is very high
Esraa Mohammed
2 years ago
-Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients
-When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
-At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation
*This retrospective study has been shown that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs.
8There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
* According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission
the patient should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting
Zahid Nabi
2 years ago
Organ shortage is becoming a real issue in world of transplantation and all efforts are made to expand the donor pool , considering primary CNS tumor donors is such an attempt.Caution is needed while making such decisions. The fact that primary CNS tumors do not metastasize unless blood brain barrier is compromised is the most important question while making such decisions.
The authors of this study have tried to look into their local data to see outcome of such donation.
Materials and Methods
Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors be- tween 1985 and 2001 inclusive with a primary intracra- nial malignancy and to identify the occurrence of post- transplant malignancy in the recipients of the organs transplanted.
Of 11 799 organ donors in the study period.
179 were identified as having had a primary in- tracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblas- tomas).
A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Muntasir Mohammed
2 years ago
1. Please provide a summary of this article Introduction:
Donors with malignancy are usually not accepted because of fear of transmission. However, risk of transmission of malignancy from primary intra cranial malignancy is rare. So, donors dying from intra cranial malignancy is an important source of organs.
In this study UK transplant registries combined with cancer registries were evaluated to find out the incidence of cancer transmission. Materials and Methods
Donors from 1985-2001 were identified, their names and other important information were sent to UK cancer registry to find out any diagnosis of malignancy at time of donation or in the past. Recipient of organs from these donors were identified and followed till end of 2006, to find out any transmission of malignancy. Results
Out of 5934 donors, 227 were identified as having one malignancy at least.
179 of these has intra cranial malignancy. None of them transmitted the disease
There is definite risk but small.
Conclusion:
Donor with malignancy can be considered after counselling the recipient and excluding high risk and metastatic ones.
Hussam Juda
2 years ago
· The use of organs from donors with primary intracranial malignancy, where the risk of spread outside the CNS, and hence the risk to transplant recipients, is low
· Council of Europe in 1997 considered organs from potential donors with high-grade malignant tumors of the CNS, unsafe for transplantation
· A recent analysis from the United States suggests that the incidence of disease transmission might be significantly lower than previously thought
· This study aim to quantify the risk of transmission of a primary intracranial malignancy from an organ donor
Materials and Methods
· demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001
· There are eight regional cancer registries in England, together with separate registries for Northern Ireland, Wales and Scotland
· Data were collected from histopathology laboratories, radiotherapy, chemotherapy and surgical units and from multidisciplinary site-specific cancer team meetings
· The records of all organ donors in the UK held on the UK Transplant Registry were identified and demographic information forwarded to each of the 10 participating cancer registries
· Using this information, all recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries
Results and Discussion
· No one of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs
· many donors with high-grade tumors, who provided organs for 85 traceable recipients
· The data here the same as the result of large study by UNOS, as only a GBM transmitted to 1.7% of recipients, with the organs were from 1 donor
· Other smaller series from transplant registries have also suggested the risk of transmission of donor intracranial cancer is small
· The Australia and New Zealand registry reported no cases of transmission in 96 recipients of organs from 28 donors with malignant primary brain tumors
· Data from Czechoslovakia showed no transmission of 11 high-grade tumors to 27 recipients, and a report from Spain also failed to demonstrate a case of transmission of organs from 9 donors with GBM.
· The occurrence of extraneural metastasis from intracranial tumors is rare, even from high-grade tumors like GBM where vascular invasion is a diagnostic feature
· Risk factor for extraneural metastasis of brain tumors:
1- Craniotomy and major resection
2- stereotactic biopsy
3- ventriculosystemic shunts
4- prior radiotherapy or chemotherapy
5- an increased time between diagnosis of tumor and death
· When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery
· any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
Naglaa Abdalla
2 years ago
Transmission of donor-related malignancy by organ transplantation is a well-recognized and often fatal complication in immunosuppressed transplant recipients.
So patients with active malignancy or treated recently are not suitable for organ donation even if no metastasis.
But donors with primary intracranial malignancy can donate organs, because the risk of spread outside the central nervous system is low and thus to the transplant recipients is also low.
However, there have been case reports of recipients where transmission of malignancy has occurred from donors with primary malignancy of the central nervous system. These cases typically involve high-grade malignant tumors in donors who have undergone
interventions that compromise the blood brain barrier and this regarded as a risk for spread outside the central nervous system.
The increasing demand and shortage of donor organs available for transplantation, make donation from a donor with primary CNS malignancy to be balanced carefully against the risk to be in a waiting list.
At present in the UK, for example, around 1 in 5 patients awaiting lung or liver transplantation dies on the waiting list.
So definite estimation of the true risk of transmission
of an intracranial malignancy is necessary for balanced
decision regarding transplantation risks to the potential
recipients. This study is done to quantify the risk of transmission of a primary intracranial malignancy from an organ donor .
The data are collected from the UK Transplant Registry
on transplant recipients and organ donors together with information on new cancers held by the UK national cancer registries.
There are eight regional cancer registries in England, together with separate registries for Northern Ireland, Wales and Scotland, and all record the occurrence and type of every primary malignancy upon diagnosis (although some registries do not record data on basal cell carcinomas of the skin) and additional data such as patient death rate.
For this analysis, information from the eight English and the Welsh and Northern Irish Registries were
available for interrogation. Information from the Scottish registry was not obtainable and consequently data were not available on around 10% of UK organ donors or on recipients living in Scotland.
The Cancer Registries coded intracranial malignancy on the basis of available histology and/or other relevant information such as cross-sectional imaging according to the 10th World Health Organization International Classification of Disease (WHO ICD-10).
The result of this retrospective study of UK registry data is that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipient who received their organs only 10 recipients developed a new non-skin invasive malignancy .
Many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
The Council of Europe guidelines states that organs from donors with high-grade brain tumors should not be used.
Because of the deficiency the cancer registries regarding the treatment of intracranial tumors, the authors are unable to define the donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculo-systemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells .
This study has more or less the same result with the only other large study from the United Network for Organ Sharing in the United States and reported the outcome of 642 recipients of organs from donors with primary intracranial tumors.
It included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred to three recipients (1.7%) of organs from one donor with a GBM . The donor had a 2-year interval from diagnosis to death, he underwent a stereotactic biopsy.
A completed course of whole brain irradiation was done
followed 1 month later by a fatal intracranial hemorrhage.
Metastatic GBM was noted in a lymph node at the time
of bilateral lung transplantation.
Transmission also occurred to the recipients of the liver and one kidney.
This particular case also emphasizes the need immediately notify other implanting teams of the same donor. Precautions :
So when potential donors with intracranial malignancy are referred, it is essential that relevant information, including tumor histology and treatment, including radiotherapy and surgery should be known.
Also examination of the thoracic and abdominal cavities for metastatic tumor should be done as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extra-neural spread. Finally the potential recipients for transplantation from donors with intracranial malignancy should be counseled regarding the small but definite risk of transmission, as well as their risk if they remain on the waiting.
Marius Badal
2 years ago
1. Please provide a summary of this article
Summary of the article.
Cancer and organ transplant have been a concern to the potential recipient due to the possible high risk of passing the same to the recipient. The article deals with deceased donors with primary intracranial malignancy if there is a risk of tumor transfer from donor to recipient.
The article aim focuses on the risk of possible tumor transmission by reviewing the incidence in patients that were transplanted in the UK.
The source of the investigation was taken from the UK Transplant Registry and from other sources from different cancer registries like England, Wales, and Northern Ireland from a period of 1985 to 2001. This inclusively includes primary cancer intracranial and how it affects the recipient post-transplant.
Based on what was obtained from the study the following results were documented.
1) There were a total of 11799 donors registered on the national transplant registry of which 179 were identified as having intracranial malignancy.
2) From the 179 donors with intracranial malignancy 582 organs were harvested. 325 were kidneys, 101 livers, 76 hearts, 71 lungs, and 9 pancreas.
3) From the 179 donors, there were 526 recipients of which some received two organs.
4) From the 526 recipients, 448 recipients were traceable by cancer registries, also some of the recipients had more than one organ transplanted.
5) Now from the 448 recipients traceable by the cancer registries, 10 of the recipients developed a new non-skin invasive malignancy and the remaining has no transmission of intracranial malignancy.
Based on European guidelines, high-grade tumors must not be used for donation due to the high risk of transmission. The risk of transmission increases with intracranial intervention. In a study conducted in the United States, there were 642 recipients of which, 1.7% of the recipients had transmission. In some other small studies, there was no form of transmission.
So in conclusion, there was no malignancy found from donors to recipients of intracranial tumors. However, proper investigations must be carried out to ensure there is no metastasis. Once a recipient is to receive a donation for a donor who is at low risk, the recipient must be informed and explained all the possible complications.
CARLOS TADEU LEONIDIO
2 years ago
Please provide a summary of this article
In general, there is a risk of transmission of donor-related malignancy by organ transplantation and in immunosuppressed transplant recipients. It’s often a fatal complication. So, organs from potential donors who have active or recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence of metastasis. However, there´s the exception for this one, which is the case of primary intracranial malignancy. This kind of malignancy is unusual.
For this study, demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001 in UK Transplant Registry and cruzed with information from the eight English and the Welsh and Northern Irish Registries. So , of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer, from whom 582 organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes and 9 pancreata. The key observation was that there were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed. Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers. As might be expected the most common type of malignancy which occurred in 4 of the 448 (1%) recipientes was posttransplant lymphoproliferative disease (PTLD).
Some centers in the world (United States, Australia, New Zealand and Spain) have a record of cases of GBM transmission to Kidney Transplant recipients and although there are few cases for analysis, it is possible to say that even small, but the risk of transmitting cancer is certain. from donors with primary intracranial malignancy.
Mohammed Sobair
2 years ago
Introduction:
Organ transplantation in donors with malignancy is contraindicated, with exception to
patient with primary brain malignancy where the risk is low. Organs from such donors
have been used for transplantation over many years, on the basis that disease
transmission was rare.
In order to quantify the risk of transmission of a primary intracranial malignancy from an
organ donor, we collated data held on the UK Transplant Registry on transplant
recipients and organ donors together with information on new cancers held by the UK
national cancer registries.
Materials and methods:
demographic information on both donor and recipient for organ transplants undertaken
between 1985 and 2001 inclusive, together with details of the organs transplanted were
reviewed.
Results:
5934 donors with the appropriate information to allow linkage to the cancer registries,
227 donors were identified as having at least one cancer, Of the 227 donors who had an
invasive malignancy, 179 had an intracranial cancer from whom 582
organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs,
93 livers, 8 liver lobes and 9 pancreas.
Twenty-four recipients received 2 organs (pancreas and kidney, liver and kidney, double
lung or double kidney), and 16 received 3 organs.
there were no recorded cases of transmission of intracranial malignancy to any of the
448 transplant recipients whose data could be analyzed.
Only 10 recipients were recorded as developing malignancy following transplantation,
excluding those who developed primary skin cancers. As might be expected the most
common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD.
Discussion:
that none of the 177 donors with primary intracranial malignancy transmitted the
malignancy to the 448 recipients who received their organs. There were many donors
with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM)
and 9 with medulloblastoma who provided organs for 85 traceable recipients.
When donors with intracranial malignancy is referred transplantation, the surgeon should
be aware of all the relevant information, including tumor histology and treatment,
including radiotherapy and surgery.
At the time of organ retrieval, a thorough examination of the thoracic and abdominal
cavities for metastatic tumor should be undertaken, as well as careful assessment of any
craniotomy site and related lymph nodes for evidence of extra neural spread; if found,
and confirmed histologically, the organs should probably not be considered for
transplantation.
Finally, it is important that any patient being considered for transplantation where
organs from donors with intracranial malignancy may be used, should be counseled
regarding the small but definite risk of transmission of malignancy.
Abhijit Patil
2 years ago
Aim:
Patients dying from primary intracranial malignancy are a potential source of organs for transplantation.
However, their use is limited by a perceived risk of tumor transfer to the organ.
The study evaluated the risk of tumor transmission by reviewing the incidence in patients transplanted in the UK.
Study design:
Information from the UK Transplant Registry was combined with national cancer registries of England, Wales and Northern Ireland to identify all organ donors
1985 – 2001
Donors with primary intracranial malignancy were included and their occurrence of post-transplant malignancy in the recipients was evaluated.
Results:
11 799 organ donors evaluated
179 had primary intracranial malignancy, with 33 as high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
A total of 448 recipients of 495 organs from 177 of these donors were identified.
No transmission of donor intracranial malignancy occurred.
Following craniotomy metastasis often manifests with infiltration around the craniotomy site, or in the ipsilateral jugular lymph nodes.
Other factors reported to increase the risk of extra neural spread, and donor cancer transmission, include ventriculosystemic shunts, prior radiotherapy or chemotherapy, and an increased time between diagnosis of tumor and death.
When potential donors with intracranial malignancy are referred, surgeon should take proper history including tumor histology and treatment (surgery and radiation)
Thorough examination of the thoracic and abdominal cavities for metastatic tumor, craniotomy site and lymph node examination should be done during organ retrieval
If anything found positive for malignancy, then such organs should not be accepted for transplantation.
Conclusion:
Organs from patients dying from even high-grade intra-cranial malignancy can be accepted.
The recipients with such organs should be counseled regarding the small definite risk of transmission against their chance of mortality if they choose to remain on the waiting list
Huda Al-Taee
2 years ago
Summary:
Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, the perceived risk of tumour transfer to the organ recipient has limited their use.
Aim: To evaluate the risk of tumour transmission by reviewing the incidence in patients transplanted in the UK.
Methods:
Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
Results:
Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor intracranial malignancy occurred.
Conclusion:
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumours, should be considered for transplantation and the small risk of tumour transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Mahmud Islam
2 years ago
In this retrospective study published in 2010, 582 organs were retrieved from 179 donors. 495organs transplanted from 177 donors (279 kidneys, one combined liver-kidney, 1 double kidney, 51 hearts, etc). The study evaluated patients between the years 1985-2001). With limited data about all cases in terms of applied treatmentsno recipient has brain tm. Cancers occurred in recepients were NLH, lung, bladder, breast etc. as detailed in table 2. In this context the risk of recurrence of brain tumors of low incidence should not discourage, rather should be weighed against continuing on dialysis. malignancies post transplantation may occur even in recepients with unknown previous maligncies.
Huda Saadeddin
2 years ago
Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, a perceived risk of tumor transfer to the organ recipient has limited their use.
Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients .
As a result, organs from potential donors who have active or recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence of metastasis.
An important exception to this rule is the use of organs from donors with primary intracranial malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low.
the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission .
In addition, many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells.
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation.
Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list.
Reem Younis
2 years ago
Please provide a summary of this article
-Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients . As a result, organs from potential donors who have active or
recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence ofmetastasis. An important exception to this rule is the use of organs from donors with primary intracranial
malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low. Organs from such donors have been used for transplantation over many years, on the basis that disease transmission was rare.
-There have been case reports of recipients where transmission of malignancy has occurred from donors with primary malignancy of the central nervous system. Since such cases typically involve high-grade malignant tumors in donors who have undergone interventions that compromise the blood brain barrier, a more selective policy for use of organs from donors with primary brain malignancy has emerged.
– Advice from the Council of Europe in 1997 stated that while the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation .
-It is retrospective study of UK registry data .
– Donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially
associated with systemic dissemination of tumor cells .
-Other smaller series from transplant registries have also suggested the risk of transmission of donor intracranial cancer is small, although the numbers of high-risk donors reported, such as those with GBM or medulloblastoma, were very small.
-The study data are very reassuring, there remains a small but definite risk of transmitting cancer from donors with primary intracranial malignancy. The occurrence of extraneural metastasis from intracranial tumors is rare, even
from high-grade tumors like GBM where vascular invasion is a diagnostic feature . Craniotomy and major resection is a risk factor for extraneural metastasis of brain
tumors and, to a lesser extent, so is stereotactic biopsy following which tumor seeding down the needle track has been observed . Following craniotomy metastasis often manifests with infiltration around the craniotomy site, or in the ipsilateral jugular lymph nodes.
– Other factors reported to increase the risk of extraneural spread, and donor cancer transmission, include ventriculosystemic shunts, prior radiotherapy or chemotherapy, and an increased time between diagnosis of tumor and death.
-About half of all intracranial tumors are not primary brain tumors, but represent secondary spread from an extraneural primary and these pose an unacceptably
high risk of disease transmission
-When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
-At the time of organ retrieval a thorough examination of the thoracic and
abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs
should probably not be considered for transplantation.
-It is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their
chance of survival if they choose to remain on the waiting list .
Hussein Bagha baghahussein@yahoo.com
2 years ago
Introduction
The number of recipients on the waiting list is increasing as is the time to receive the transplant. This is due to the reducing pool of deceased donors. Donors with malignancies are disqualified from donating. Transplant centers are also shying away from utilizing donors with primary intracranial malignancies. This was a retrospective survey that looked at recipients who got organs from donors with primary intracranial malignancies Methodology
Data was obtained from the UK registry for all donors utilized during the time period of 1985-2001.
Demographic data for 11,799 donors from the UK transplant registry from 1985-2010 was forwarded to the 10 participating UK cancer registries.
227 donors were identified as having at least one cancer from which 179 had a primary intracranial malignancy. Out of the 179 donors who had a primary intracranial malignancy, 33 had a high grade malignancy. 526 recipients received organs from these donors. Data was only available for 448 recipients. Results
There was no transmission of intracranial malignancy that occurred in the recipients.
The data presented here are reassuring and are in agreement with the only other large study which is from UNOS in the U.S and reported the outcomes of 642 recipients of organs from donors with primary intracranial tumors. The series included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred in 3 recipients.
The cancer registries classify tumors according to The Who 10th ICD, and although data were not available on the mode of diagnosis of the tumor, it is likely that in a small proportion of donors the diagnosis was made solely on the appearance of cross-sectional imaging with no corroborative histology Conclusion
This study demonstrates that organs from donors with primary intracranial malignancies can be safely transplanted as long s it is not a high grade tumor, it is not a recurrence, no surgical interventions like debulking or ventriculosystemic shunting or radiotherapy was done
When potential donors with intracranial malignancy are referred, it is essential that the surgeon should be aware of all the relevant information including tumor histology, and treatment including radiotherapy and surgery. At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken as well as careful assessment of any craniotomy site and related lymph nodes for any evidence of extra-neural spread
Sahar elkharraz
2 years ago
This article is retrospective study focus on transmission of donor primary intracranial malignancy to transplant kidney.
This study done between 1985 and 2001 includes cases with a primary intracranial malignancy and to identify the occurrence of post transplant malignancy in the recipients of the organs transplanted.
The primary intracranial malignancy including with high-grade malignancy of gliomas and medulloblastomas).
This study shows No transmission of donor intracranial malignancy occurred.
Transmission of donor related malignancy by organ transplantation is serious fatal complication in immunosuppressed transplant recipients. So organs from donors who have active or recently treated malignant disease are not considered suitable for transplantation, even when there is no evidence of metastasis.
But there’s exception for donors with primary intracranial malignancy, where the risk of spread outside the central nervous system low. Organs from such donors can be used for transplantation over many years, on the basis that disease transmission was rare.
Donors with low grade primary malignancy was safe.
Donors with high grade malignant tumors of the CNS where the integrity of the blood brain barrier is compromised, should no considered for transplantation. The incidence of disease transmission might be significantly lower than previously thought.
The shortage of donor organs available for transplantation is the cause to consider risks of disease transmission by organs from a donor with primary CNS malignancy studied carefully against the risk of recipient remaining on the waiting list for transplantion.
Demographic data collected from
Cancer registries in the UK and it’s population-based and collect data from histopathology laboratories, radiotherapy, chemotherapy and surgical units and from multidisciplinary site specific cancer team meetings.
this study shows no development of cancer fallow transplant in patients received kidney donor with primary intracranial malignancy but very few of them develop posttransplant lymphoproliferative disease.
the key observation of cases there’s no transmission of intracranial malignancy to any of the selected cases of transplant recipients whose data was analyzed.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission. Many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cell. There’s no complete data on treatment of primary intracranial tumors in donor.
Death from primary intracranial tumor in donor was uncertain and Metastatic glioblastoma was noted in a lymph node at the time of bilateral lung transplantation. this was transferred to recipient liver and one kidney. This study advice to decline donors with intracranial shunts and previous craniotomy and or radiotherapy. It’s less act of commission where as recipient with malignant donor die fallow transplant may claim it mis related to transmission of malignant donor.
It’s should be counselling any recipient with malignant donor there is very little risk of transmission of primary intracranial cancer.
Heba Wagdy
2 years ago
Donors with active malignancy or recently treated malignancy are excluded from donation because of the risk of transmission of malignancy to the recipient, on the other hand, patients with primary intracranial malignancies are accepted for donation as the risk of transmission is low, also, the increased demand for organ donors forced to accept unsuitable potential donors with intracranial malignancy.
However, case reports of transmission of malignancy to recipients were reported in donors with high grade malignancy and more selective policy was approached.
The risk of transmission of intracranial malignancy should be balanced against the risk of remaining on waiting list for transplantation.
This retrospective study aimed to evaluate the risk of transmission of primary intracranial malignancy from organ donor.
It analyzed information from UK transplant registry and national cancer registries, 179 organ donors had a primary intracranial malignancy and 448 recipients of 495 organs were included.
The study showed that none of the donors transmitted malignancy to the 448 recipients including donors with high grade tumors.
Although the results were reassuring, there was a definite small risk of cancer transmission from donors with primary intracranial malignancy, the risk of extra-neural transmission is rare but increases with high grade tumors, craniotomy, major resection, chemotherapy, radiotherapy and increased time between diagnosis and death,
Any patient considered for transplantation from a donor with intracranial malignancy should be counseled about the risk of malignancy transmission and the risk of remaining on the waiting list.
Abdullah hindawy
2 years ago
Please provide a summary of this article
this article focuses on the saftey of using organs from patients who have primary brain malignancy and the risk of tranrnsmision to the recipent,
This retrospective study of UK registry data has shown that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs. There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients,
the study shows No transmission of intracranial malignancy ,
Nandita Sugumar
2 years ago
Summary
This article is about the usage of organs from deceased donors with primary intracranial malignancy. Although a small risk of malignancy can be transferred to the recipient, the given study has found no evidence of such. The authors of this study thus recommend the acceptance of deceased organ donors even if they have high grade primary CNS malignancies with a small risk of transfer to recipient, keeping in view the risk of malignancy if the recipient remains chronically on the waiting list.
Factors that can determine increased risk of cancer transmission to recipient from such donors include :
ventriculosystemic shunts
craniotomy metastasis – infiltration around craniotomy site or ipsilateral jugular lymph nodes.
prior radiotherapy
prior chemotherapy
increased time between diagnosis of tumor and death
It is important for the surgeon to be aware of tumor histology and treatment, radiotherapy and prior surgery before accepting the donor. Examination of thoracic and abdominal cavities is very important. Lymph nodes need to be checked, and if there is evidence of spread here then the organ is recommended not to be considered for transplantation.
Recipient counseling is very important before proceeding for transplantation – the small but definite risk of cancer transmission. Full information should be given about consequences in case the recipient refuses the donor and chooses to remain on the waiting list for a longer period of time. This can lead to increased risk of mortality.
Wael Jebur
2 years ago
Malignancy was always the main impediment for donating an organ , instigated from the fear that transplanting an organ from a donor with malignancy might transfer the same malignancy to the recipient with the mounting risk integral to the immunosuppressed status of the recipient. Therefore , the transplant guidelines have revoked the donation from a malignancy donor, and set a time frame for donation relative to each type of malignancy after squared remission.
The story is different with intra cranial malignancy as its inherently metastasize locally with no distant or systemic metastasis. Nevertheless, few anecdotal reports elucidated the occurrence of distant metastasis secondary to transplanting organs from donors with intra-cranial malignancy.
To test this proposition , this retrospective study was conducted in UK from UK transplant registry kept in NHS along with UK cancer registry data, by reviewing the the records of organ transplant recipients conducted between 1984 and 2001.
179 donors were identified as having primary intracranial tumors . 33 of them were high grade malignancy (grade IV glioma and Medulloplastoma).
The entire recipients were 448 for 495 organs from 177 donors.
This study concluded , that there is no reported transmission of malignancy to any of the recipients in this cohort. Which is in agreement with several other studies that concluded the same .
Dr. Tufayel Chowdhury
2 years ago
Organs from active malignancy or recently treated malignant disease are not suitable for transplantation , exception is primary intracranial malignancy. However, there are case reports where transmission of malignancy occurs from donor with primary intracranial neoplasm.
This retrospective study was done to evaluate the risk of tumor transmission from a donor with a primary intracranial malignancy.
Information obtained from UK Transplant registry combined with from the national cancer registries of England, WAles and Northern Ireland between 1985 and 2001.
Among 11799 patients, 179 were identified having primary intracranial malignancy including 24 grade IV gliomas and 9 medulloblastomas.
No transmission of donor intracranial malignancy occured.
In conclusion , primary intracranial malignancy patient can be accepted as potential donor with some risk of transmission.
Active or recently treated malignancy is an absolute contraindication of transplantation
Primary intracranial malignancy may be an exception as the risk of transmission is low
Despite that transmission occurred in many cases with high grade malignancy with intervensions that involve the BBB
Aim of the study
Retrospective study of UK registry data to identify the incidence of primary intracranial malignancy from an organ donor
Materials and Methods
Both donors and recipients in UK were include (1985 and 2001)
Data from the UK Transplant Registry, the national cancer registries of England, Wales and Northern Ireland Donors and recipients
Results
From the 11799 Donors, 179 had an intracranial malignancy (donated 582 organs to 526 Recipients)
The 179 donors including high grade tumours:
Grade IV gliomas (n=23)
Medulloblastoma (n=9)
No any transmission of malignancy from donors of intracranial malignancy
Discussion
According to the Council of Europe guidelines, high grade tumours should not be used for donation as the risk of tramsmission is high. The risk increases with intervensions
No complete data for treatment of intracranial tumours (intervensions that breach the BBB may be missed)
No data for how tumours was diagnosed (may relied only on imaging and no histology)
This data agreed the large study of the United Network for Organ Sharing in the United States. They studied 642 recipients of organs from donors with primary intracranial tumors (175 recipients where the donor tumor was a GBM). Transmission occurred to three recipients (1.7%) of organs from one donor with a GBM
In other small studies, no transmission
In the IPITTR, 34 organs from donors with high- grade gliomas (4 grade III, 30 grade IV), 25% incidence of transmission from organ donors with grade III gliomas and 40% transmission from donors with GBM
This data although reassuring, it is small
At the time of retrieval, examination in details is paramount to look for any possible transmission of malignancy
Conclusion
No malignancy transmission of donors with intracranial malignancy
Donors with intracranial malignancy including those with high grade toumours should be considered
The small risk of transmission should be balanced with long waiting list of organ transplant and adverse outcome
The IPITTR information was accused of over recording bias the results are therefore overlooked.
Hinda Hassan
2 years ago
Intracranial primary tumors in organ donors were not considered as a contraindication for donation. The Council of Europe guidelines stated that high-grade brain tumors patients should not donate their organs . Those donors carry high risk of transmission of their cancer plus they have gone through interventions that might disrupt blood brain barriers with dissemination of malignant cells systemically. Recently some reports have contradicted this. This is a retrospective analysis of UK registry data between 1985 and 2001. The aim of this study is to quantify the risk of transmission of a primary intracranial malignancy from an organ donor. 179 out of 11799 organ donors had a primary intracranial malignancy ( 33 with high-grade malignancy) . They donated their organs to 526 recipients and the researcher found the data of 448 recipients (495 organs).
Only 10 patients developed malignancy after transplantation. No transmission of donor intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation. The possible risk of tumor transmission should be weighed against the likely mortality from being remained on the transplant waiting list.
This is a study that cross-references information from UK transplant and cancer registries in an attempt to establish whether malignant brain neoplasms have the potential to be transmitted from donor to recipient of solid organ transplants. Currently, potential donors with malignant neoplasm of the central nervous system are unable to complete the procedure.
Data were collected in a retrospective cohort from 1985 to 2001 with 11,799 donors and crossing the data with ten cancer centers obtaining data from 5934 patients, where 179 had central nervous system neoplasm, where 23 had glioblastoma multiforme and 9 medulloblastomas.
Most post-transplant neoplasms are related to PTLD, with no primary CNS disease involved. With the dwindling availability of deceased donor organs, there is a need not to restrict supply unnecessarily. Situations such as aggressive disease with metastasis or lymphatic or vascular invasion, ventricular shunts, and radiotherapy could be considered when not accepting the organ for donation.
To minimize the risk of transmission of malignancy in these situations, a thorough examination of the thoracic and abdominal cavities in an attempt to find metastases or lymph node enlargement to suspend the donation process.
This study suggests that potential patients to donate an organ should not be automatically excluded when having a diagnosis of central nervous system neoplasm, individualizing the choice process on a case-by-case basis depending on the invasiveness and expansion of the disease.
Because of scarcity of organ donation we might accept some donors with risk like donor with primary intracranial tumors ,as we are weighing whether to keep the recipient on dialysis or take organ with very low risk according to the recent EBM,
As all recents data denotes that all primary intra cranial tumor which is very localized and not invade the BBB or did surgical intervention like shunt has very low risk to be metastesized .
this study was a retrospective analyzing data for the UK register data
found that 177 donors gave their organs to the 448 recipients ,No one of the recipient developed malignancy and most of them were quiet well .another two study were held in US and Australia both of them consolidated that there is no risk of transmission from the donor with primary IC cancer and even among those with advance stages .
These data should be taken with consideration that donors with IC shunts, craniotomy &/or radiotherapy are likely to have been selectively declined. ·On organ retrieval all body cavities should be well examined for any evidence of metastatic tumor as well search for any craniotomy site & related lymph nodes for evidence of spread. ·Patients should be counseled about the small but definite risk of transmission, & also chance of survival if they choose to remain on the waiting list.
The occurrence of extraneural metastasis from intracranial tumors is rare, even from high-grade tumors like GBM where vascular invasion is a diagnostic feature
Craniotomy and major resection is a risk factor for extraneural metastasis of brain tumors
Following craniotomy metastasis often manifests with infiltration around the craniotomy site, or in the ipsilateral jugular lymph nodes. Other factors reported to increase the risk of extraneural spread, and donor cancer transmission, include ventriculosystemic shunts, prior radiotherapy or chemotherapy, and an increased time between diagnosis of tumor and death.
It is important to note that about half of all intracranial tumors are not primary brain tumors, but represent secondary spread from an extraneural primary and these pose an unacceptably high risk of disease transmission
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including:
tumor histology and treatment,
radiotherapy and surgery.
At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread;
if found, and confirmed histologically, the organs should probably not be considered for transplantation.
Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
1. Please provide a summary of this article Introduction
·Generally, organs from donors with active or recently treated malignancy are not suitable for donation; however, primary IC malignancy is an exception to this rule as the risk of metastasis outside the CNS, & thus the risk to recipients, is low.
·The Council of Europe in 1997 stated: “while the use of organs from donors with low-grade primary malignancy is safe, organs from donors with high-grade malignant tumors of the CNS, (especially where the integrity of the BBB) is compromised, should not be considered safe for transplantation.”
·A recent analysis from the US reports that the incidence of transmission might be markedly lower than previously thought.
·Due to the shortage of donor organs the risks of disease transmission from a donor with primary CNS malignancy is to be carefully balanced versus the risk of potential recipients remaining on the transplant waiting list. The study
Aimed to quantify the risk of transmission of primary IC malignancy from an organ donor from data on the UK Transplant Registry for transplant recipients & organ donors & data on new cancers from the UK national cancer registries. Flow chart of the study:
·Donors on national transplant registry: 11799:
–5827 with NHS number on UK Transplant Registry
–107 idenitified via NHS STS.
–5865 with no NHS number & not found by NHS STS
·179 Donors identified with an IC malignancy, & transplanted to:
–582 (325 Kidneys, 101 Livers (whole or lobes), 76 Hearts, 71 Lungs, & 9 Pancreas).
·526 Recipients: 18 recipients from Scotland (12 kidneys, 3 livers, 3 hearts) 60 recipients have insufficient data to trace
4 heart-lung, 1 double lung, 6 hearts, 1 single lung, 23 kidneys, 25 livers (inc.1 lobe)
·448 Recipients (out of 526) traceableby cancer registries: 495 Organs transplanted from 177 donors
279 Kidneys
1 Double kidney
72 Liver (65 whole, 7 lobes)
1 Liver + kidney
12 Heart + double lung
13 Double lung
51 Hearts
10 Single Lungs
8 Pancreas + kidney
1 Solitary pancreas
·10 Recipients subsequently developed a new non-skin invasive malignancy: No transmission of intracranial malignancy Discussion
·This retrospective study of UK registry data shows that none of 177 donors with primary
IC malignancy transmitted the disease to the 448 recipients who received their organs.
·Many donors had high-grade tumors (23 grade IV GBM & 9 with medulloblastoma who
provided organs for 85 traceable recipients).
·The number of potential organ donors in the UK who died from primary IC malignancy is
unknown.
·It is also difficult to quantify the number of potential recipients who have died on the
waiting list for lack of an organ that could have been provided by such a donor.
·Guidelines issued by the Council of Europe not be taken separately, but the risk of
disease transmission should be balanced versus the risk of recipient death without a
transplant.
·Because of the reduction in the number of deceased organ donors, there is a tendency
to consider using organs from potential donors that previously have been deemed
unacceptable, e.g. donors with a H/O IC malignancy.
·The results of this study are reassuring.
·In agreement with this study, the only other large study (from UNOS in the US) reported
the outcome of 642 recipients of organs from donors with primary IC tumors. It included 175 recipients where donor tumor was a GBM & the only transmission was in 3 recipients (1.7%) of organs from 1 donor with a GBM.
·This indicates the need for the surgeons implanting an organ to notify the surgeons
implanting other organs from the same donor whenever they identify a suspicious
finding so to allow a timely decision to be taken whether to proceed or not.
·The Australia & New Zealand registry reported no cases of transmission in 96 recipients
of organs from 28 donors with malignant primary brain tumors, including 4 with GBM.
·Despite these reassuring data, there is still a small but definite risk of transmitting
cancer from donors with primary IC malignancy. Extraneural metastasis from IC tumors
is rare, even from GBM where vascular invasion is diagnostic.
·Craniotomy & major resection is a risk factor for extraneural metastasis of brain tumors.
·Other factors for extraneural spread cancer transmission are:
-Ventriculosystemic shunts
-Prior radiotherapy or chemotherapy
-Increased time between diagnosis of tumor & death.
· These data should be taken with consideration that donors with IC shunts, craniotomy
&/or radiotherapy are likely to have been selectively declined.
·On organ retrieval all body cavities should be well examined for any evidence of
metastatic tumor as well search for any craniotomy site & related lymph nodes for
evidence of spread.
·Patients should be counseled about the small but definite risk of transmission, & also
chance of survival if they choose to remain on the waiting list.
Summary of the article How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data
This is a retrospective study of the UK transplant registry/NHS in the period between 1985 and 2001 inclusive, together with details of the organs transplanted were reviewed. 11,799 deceased organ donors were notified to the UK Transplant Registry, Of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer, from whom 582 organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes and 9 pancreata. Of the 526 recipients, data were available for 448 recipients who received 495 organs from 177 donors with primary intracranial malignancy
Study Result and outcome 1. There were no reported cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed. 2. The risk of transmission of donor intracranial cancer is small. 3. Factors reported to increase the risk of extraneural spread: a) Craniotomy. b) Ventriculosystemic shunts. c) Prior radiotherapy or chemotherapy. d) An increased time between diagnosis of tumor and death.
Summarize the article:
Immunosuppressant medications is a risk factor of developing malignant tumor, as well as aggravating transmitted malignant tumor from donor to recipient, and i will fatal and complicate death and graft survival.
Delayed donation from patient with recent malignant tumor treated or on treatment is vital to ensure that the donor is free from any residual malignant tumor.
The Council of Europe in 1997, stated that while the donation from donor with low grade malignancy was safe, donation from donor with high grade malignancy have no considered safe and should be excluded from donation.
In ordered to make organ for donation available, the risk of disease transmission from malignant CNS tumor should be balanced carefully against risk of complication may develop as well as death in recipient waiting for transplantation. Results:
data collected from 11,799 DOD in UK Transplant registry between 1985-2001. Among 5934 donors who registered to the cancer registries. Donors grouped as follow.
227 donors identified as having at least one cancer, excluded from nonmelanoma skin cancer
No recorded cases of transmission of intracranial malignancy, whose data analyzed.
4 cases develop the most popular types of malignancy post Tx; PLLD.
discussion:
No intracranial malignancy transmitted to the recipients, although many undergo debulking surgery, radiation, and shunting which is not precipitate transmission.
High grade tumor should not be considered for donation.
According to the Council of Europe, the risk of disease transmission should be balanced against recipients’ death without a transplant.
As number of deceased organs for donation shortages, surgeons should consider use of deceased organ who’s considered before as unsuitable for donation.
The Australia and New Zeland, registry reported no cases of transmission in 96 recipients of organs from 28 donors with malignant primary tumor, in whom 3 had venrticulo-peritoneal shunts.
– Although patients dying from 1ry intracranial malignancy is a potential source of organs for donation , there is a risk for tumour transfer the the recipient , so this study collected Information from the UK Transplant Registry combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and analyses to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
– 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
– A total of 448 recipients of 495 organs from 177 of these donors were identified.
– No transmission of donor intracranial malignancy occurred.
– So , Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list but it is essential that the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
– At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation.
– Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients.
An important exception to this rule is the use of organs from donors with primary intracranial malignancy, where the risk of spread outside the CNS , and hence the risk to transplant recipients, is low.
The UK Transplant Registry is maintained by (NHS) Blood and Transplant.
This study, demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001 .
Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
Totatly 11,799 deceased organ donors notified to the UK Transplant Registry between 1985 and 2001 to 10 participating UK cancer registries.
Only 10 recipients were recordedas developing malignancy following transplantation, excluding those who developed primary skin cancers.
As might be expected the most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was posttransplant lymphoproliferative disease (PTLD).
This retrospective study of UK registry data has shown that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs.
There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission .
In addition, many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells .
.
The total number of potential organ donors in the UK who died from primary intracranial malignancy is uncertain since following publication of the European Guidelines, many potential donors would not have been considered suitable for organ donation .
Decision making about organ usage for transplantation is seldom straightforward, and has become less so in recent years .
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list .
No transmission of donor intracranial malignancy occurred.
————————————————————————————————————————————————————————————————————————————–
Conclusion:
DONOR with primary intracranial malignancy ——— investigated for histology type , size, extension, and distant metastasis before consideration of organ donation.
At the time of organ retrieval, donors should be evaluated for metastasis.
Even when the risk of cancer transmission is low, recipients should be informed about the potential risk of cancer transmission .
Kidneys from cadaveric donors have been the predominant source of allografts in most countries due to the global shortage of kidney donors. Some researchers have proposed using organs from people who have primary intracranial cancer pending circulatory arrest.
Methods and Materials.
The potential for tumor spread from a donor with primary intracranial malignancy was assessed in this retrospective analysis. All organ donors with primary intracranial malignancy between 1985 and 2001 inclusive were identified, and the incidence of post-transplant malignancy in recipients of these organs was determined using data from the UK Transplant Registry and the national cancer registries of England, Wales, and Northern Ireland.179 donors identified with an intracranial malignancy donated organs to 526 recipients, and 448 recipients were tracked by cancer registries.
Results:
Only 5827 donors (49%) had a valid NHS number and were allowed direct link to the cancer registry data. An additional 107 donors were added after a manual investigation and after analysis of the data of those donors, only 179 donors were found to have intra-cranial cancer who transplanted 582 organs in 526 recipients with 325 kidneys, 76 hearts, 71 lungs, and 93 livers. Twenty-four recipients received two organs . This observational evaluation revealed no risk of intracranial tumor transmission to any of the registered 448 transplant recipients, despite the fact that 23 percent of recipients lacked complete data.
Conclusion:
Patients with primary intracranial malignancy should be investigated for histology type , size, extension, and distant metastasis before consideration of organ donation. At the time of organ retrieval, donors should be evaluated for metastasis.
Even when the risk of cancer transmission is low, recipients should be informed about the potential risk of cancer transmission .
In immunosuppressed transplant recipients, transmission of donor-related malignancy via organ transplantation is a well-known and frequently deadly complication. As a result, even when there is no sign of metastasis, organs from potential donors who have active or recently treated malignant disease are typically not deemed appropriate for transplantation.
The use of organs from donors who have primary intracranial cancer, where the likelihood of spread outside the central nervous system, and consequently the risk to transplant recipients, is low, is a significant exception to this norm.
In 1997, the Council of Europe declared that although the use of organs from donors with low-grade primary malignancies was safe, organs from potential donors with high-grade malignant tumors of the central nervous system, particularly in cases where the blood-brain barrier’s integrity was weakened, should no longer be regarded as safe for transplantation.
Method
All UK transplant registry records for organ donors were located, and demographic data was sent to each of the 10 collaborating cancer registries. The data was then processed by the registries to identify organ donors who had a malignancy (current or past) noted in their medical history. These details were used to identify all recipients of organs from donors with a history of cancer from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006. This gave all transplant recipients a minimum follow-up period of five years.
The Council of Europe rules state that high-grade brain tumor donors’ organs should not be used due to the alleged increased risk of cancer transmission. Additionally, many donors who had primary intracranial cancer would have undergone procedures like debulking surgery, radiation, and the installation of ventriculosystemic shunts, all of which disrupt the blood-brain barrier and may be linked to systemic tumor cell dissemination.
The study was unable to identify the percentage of donors in the data set who received such interventions because the cancer registries did not keep complete records of the treatment of intracranial tumors.
Risk factors for brain tumor extraneural metastasis include craniotomies and significant resections, as well as stereotactic biopsy, which has been associated with tumor seeding down the needle route.
Ventriculosystemic shunts, prior radiotherapy or chemotherapy, and a longer interval between a tumor’s detection and death are a few other characteristics that have been linked to an increased chance of extraneural spread and donor cancer transmission.
The fact that roughly half of all intracranial tumors are secondary spread from extraneural primary tumors rather than primary brain tumors, which carry an unacceptable risk of disease transmission, should be noted.
Summary of this article
Introduction
Donors who have active or recently treated malignant disease are not suitable for transplant except donors with primary intracranial malignancy as the risk of transmission is low. However case report of recipient had transmission of malignancy from donors with primary malignancy of CNS.
we need to weight the risk of the donor organ shortage for transplantation with the risk of primary CNS malignancy transmission.
The UK transplant registrar by NHS blood and transplant for organ transplant between 1985 and 2001.
Cancer registers in UK are population based collect data from histopathology ,laboratory ,radiotherapy ,chemotherapy and surgical unit and from multidisciplinary site specific cancer team meeting.
RESULT
Data from 11799 deceased organ donors notified to the UK transplant registry between 1985 to 2001 to the 10 participant UK cancer registries .
107 donors were identified by mainly investigating each donor using the NHS strategic tracing service.
From 5934 donors 227 donors having at least one cancer .
227 had an invasive malignancy.
179 had an intracranial cancer .
There were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients.
Discussion
Retrospective study of UK registry data showed that no any of the 448 recipients who received organ from 177 donors with primary intracranial malignancy .
23 donors with grate 4 glioma .
9 with modulo blastoma .
As there is high risk of cancer transmission from donor with high grate of brain tumour The council of Europe guidelines for bidden this type of organ transplant.
In transplant registries with some cases series they concluded that the risk of transmission of donor in cranial carcinoma is small.
But others transplant registry centre they summarized that donors with high grate ,the incidence of tumour transmission from organ donors is high 25%.
The surgeon should aware about donors with intracranial malignancy such as tumour histology and treatment include radiotherapy and surgery.
Communication with patients regarding his chance of transplant from the waiting list and as well there is risk of intracranial malignancy from donors.
Please revise the PI last paragraph due to over recording bias
Isaac Abiola
2 years ago
SUMMARY
Introduction
There is an ever-increasing demand for organ due to long list those waiting for organs, despite this, organs from potential donors but with active or recently treated malignancy are being discarded because of concern of transmitting of the malignancy despite the extreme shortage. The council of Europe, advice the use of organs from donors’ low-grade intracranial malignancy while to preclude those with high grade despite different publication attesting to very small risk of transmission of the malignancy except in some circumstances like bridge of the CNS circulation.
Materials and Methods
of the total donor of 11799 from NHS blood and transplant done between 1985- 2001, 179 donors identified as having intracranial tumor
of the 277 donors with invasive malignancy, 179 had intracranial malignancy
526 recipients received various organs from the 179 donors with over 50% of them kidneys donations
10 participating cancer registries were used
the minimum follows up years for those that received organs was 5 years
Results
of the 526 recipients of various organs from donors with intracranial malignancy, about 325 received kidneys
out of the 526 recipients, data were available for 448 recipients who received 495 organs from 177 with intracranial malignancy
there was no reported case of transmission of malignancy to any the 448 recipients that the data were analyzed
4 malignancies recorded among the 448 were PTLD, but others that were skin cancer were excluded from the study
85 recipients were traced to have received organ from 23 donors with high grade intracranial tumors without any record of transmitting it to the recipients
Conclusion
The concern that has been entertained on rate of transmission of malignancy from a potential donor to recipient of various organ seems not as serious as it was made to be by the council of Europe, and this has been attested to by various studies from Australia, New Zealand, and Czechoslovakia. Although, transplant surgeons were advised to watch out for features of cancers while transplanting an organ so as to alert others using other organs from the same donor. Moreso, recipient should be fully aware of the kind of potential donor they are receiving organ from of the possibility of transmission of cancer though remote.
mode of treatments like radiotherapy or surgical removal of tumor that can bridge the CNS
brain biopsy
ventriculoatrial shunt
Mohamed Saad
2 years ago
How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data.
The target worldwide is to increase organ donor pool, this will occur with some challenges, one of these is transplantation from cadaveric. Here the question is about safety of transplantation from donor with primary intracranial malignancy. Materials and Methods.
This is done in this retrospective study by evaluating the risk of tumor transmission by reviewing the incidence in patients transplanted in the UK. Data collected from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of post-transplant malignancy in the recipients of the organs transplanted.
179 donors identified with an intracranial malignancy donates organs for 526 recipients and 448 Recipients traceable by cancer registries. Results:
Only 10 recipients were recorded as developing malignancy following transplantation, a new non-skin invasive malignancy, the most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD and no transmission of intracranial malignancy. Conclusion:
When potential donors with intracranial malignancy are referred, we should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery. At the time of organ retrieval, we should looking for any metastasis.
Transplantation from donors with intracranial malignancy may be used, we should counsel regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list.
Summary Introduction
With the increase in the demand for organ supply to shorten the waiting list for organ transplantation may consider patients dying from primary intracranial tumors as a source of organs for transplantation. However, the use of such types of donors may be limited due to the risk of tumor transmission to the organ recipients however this should be wisely well-adjusted against the risk of potential recipient death while waiting of dialysis.
Aim of the study
To estimate the incidence of primary intracranial tumor transfer from organ donors based on a review of the data from both the UK transplant registry along with the national cancer registry in the UK
. Methods
All donor’s and recipient’s demographics are collected and found on 81% of the cases by ID numbers from the national health service registry (NHS) as the UK transplant registry maintained by NHS from the period 1985-2001 and linked to the data registry from the national cancer registry and another 19% by using other demographic data (total of 8 regional cancer registries in the UK, North Ireland Wales and Scotland.
The cancer registry collects data from histopathology labs, radiotherapy, chemotherapy, surgical units, and MDT site-specific cancer team meeting, and review of the death certificates of the registrable neoplasm from the office of national statistics the data was available for 94% of all malignancies accept the nonmelanoma skin cancers, they identify 179 DD donors with intracranial tumor and 448 recipients with cancer with minimum FU of 5 years for all recipients.
Results
A total of 11,799 was notified by the UK registry from 1985-2001 only 5827 donors (49%) had a valid NHS number and were allowed direct link to the cancer registry data additional 107 donors were added after a manual investigation and after analysis of the data of those donors only 179 donors found to have intra cranial cancer who transplanted 582 organs in 526 recipients with 325 kidneys, 76 hearts, 71 lungs, and 93 livers, 24 recipients got two organs ( kidney and pancreas, liver and kidney, double lungs or double kidneys also the data for recipients available in 448, there is missing data in 23% of recipients, this observational review did not show any risk of intracranial tumor transmission to any of the registered 448 transplant recipients Discussion This is a retrospective UK registry observational study that reported that none of 177 DD with primary CNS tumors transmitted the malignancy to 448 recipients including high-grade tumors in 32 cases. and it was similar to the finding of other small studies from US and Australian registries and the agreements that the risk is trivial and only those with high-grade tumors with a history of intervention may consider for further discussion due to few reported cases of systemic transmission upon follow-up of the recipients. The risk of extra neural metastasis from intracranial tumors is rare even from high-grade tumors like GBM with vascular invasion. But those with a history of interventions like surgical debulking, craniotomy, shunt placement, chemotherapy, or radiation can break the BBB, and associated with the risk of tumor seeding around and down to the lymph nodes, However, the Council of Europe guidelines recommended that donors with high-grade brain tumors should be rejected due to the high risk of cancer transmission (5). We should take into consideration the above risk and the selection of the DD with primary intracranial tumor should be highly selective taking into consideration the low risk of tumor transmission we should not decline such donors unless they have high-grade tumors with recent intervention radiation and should balance with the risk of recipient mortality on the long waiting list on dialysis, we need larger studies in prospective design and longer Fu to address this limitation. Limitation
Retrospective study with missing data of half of the registered cases (49%) of the donors (bias, underestimation)
Missing data about the treatments, and interventions that can affect the results (bias underestimation)
Missing data about the diagnostic criteria of a tumor carry the risk of under or overestimation the grade of the tumor
Missing data about the total number of deaths among donors with primary CNS tumors and among recipients on the waiting list.
Previous studies reported increased risk for malignant transmission from donors with primary intracranial tumors if there is one of the following risk factors including high grade tumors, previous craniotomy, intake of systemic chemotherapy and the presence of ventriculo-atria or ventriculo- peritoneal shunts that disrupt the blood brain barrier
This is a retrospective study evaluating 179 deceased donor with primary intracranial malignancy of which 33 were high grade (24 grade IV gliomas and 9 medulloblastomas) diagnosed by imaging and/or histology regarding transmission of donor malignancy to the recipients
Results
No transmission of donor malignancy reported in all cases
Conclusion
Deceased donors with primary intracranial malignancy can be considered for donation since they have very low risk of malignant transmission to the recipients even those with high grade malignancy.
Material and Methods:
NHS Blood and Transplant maintain the UK Transplant Registry. This retrospective cohort study evaluated donor and recipient demographics and organ transplant records from 1985 to 2001. Name, NHS number, date of birth, gender, and postcode were needed to connect to cancer registry databases. In 81% of instances, the connection was based on NHS numbers and 19% on demographic information. Population-based cancer registries in the UK gather data from histology labs, radiation, chemotherapy, and surgical facilities, and multidisciplinary site-specific cancer team meetings.
Results:
Of the 5934 donors with the necessary, 227 had at least one cancer, Of the 227 donors with invasive disease, 179 had intracranial cancer.325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes, and 9 pancreases were transplanted. 24 people received 2 organs (pancreas and kidney, liver and kidney, double lung or double kidney), and 16 got 3. (all heart and lung transplants).448 of 526 patients with primary intracranial cancer got 495 organs. The significant finding was that none of the 448 transplant patients whose data could be evaluated had intracranial cancer. 10 transplant recipients developed cancer. As predicted, 4 of 448 (1%) patients developed PTLD.
Discussion:
When prospective donors with intracranial malignancy are referred, the surgeon must know tumour histology and treatment, including radiation and surgery. At the time of organ retrieval, the thoracic and abdominal cavities should be examined for metastatic tumour, as well as any craniotomy site and adjacent lymph nodes for extraneural dissemination; if identified, and proven histologically, the organs should not be considered for transplantation. Any patient considering transplantation where organs from intracranial cancer donors may be utilized should be educated about the modest but clear risk of transmission, as well as their probability of survival if they opt to wait.
Conclusion:
Primary intracranial cancer patients may donate organs.
A fear of tumour transmission has restricted their usage. We analyzed tumour transmission risk in UK transplant patients. 179 of 11 799 organ donors had primary intracranial cancer, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). From 177 donors, 448 people received 495 organs. No intracranial cancer was transmitted.
The huge need for organs to the patients on the waiting list, makes it worthy to look after those cadaver donors and their cause of death, this study consider those with known malignancy by the UK transplant registry(NHS), form those 177 donors known to have brain tumor, 495 organs were transplanted in to 448 donors, 10Recipients developed a new non-skin invasive malignancy. out of them 23 donors had grade IV glioblastoma, and 9 with medulloblastoma- provided organs to 85 donors, many would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells. in a series included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred to three recipients, Metastatic GBM was noted in a lymph node at the time of bilateral lung transplantation; it was also transferred to the recipients of the liver and one kidney. Detailed information of the patient history is must, pathological diagnosis, h/o intracranial shunts and previous craniotomy, radiotherapy. and at the time of organ retrieval, a thorough examination of the thoracic and abdominal cavities for metastatic tumor, careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread should be done, if present and histologically evident organ decline is proper. Any patient being considered for transplantation from donors with intracranial malignancy, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list.
demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001
cancer registry data bases
81% of cases, linkage was achieved on the basis of NHS number
and in the remaining 19% by using other demographic information.
There are eight regional cancer registries in England
The Cancer Registries coded intracranial malignancy on the basis of available histology and/or other relevant information such as cross-sectional imaging according to the 10th (WHO ICD-10).
Results:
Demographic data from 11,799 deceased organ donors
between 1985- 2001
5934 donors with the appropriate information to allow linkage to the cancer registries,
227 donors were identified as having at least one cancer, excluding those with
a non melanoma skin cancer,
benign tumor,
in situ tumor
and those where the histology was graded as ‘borderline’ for malignancy.
Of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer
from whom 582 organs were transplanted into
526 recipients, including
325 kidneys,
76 hearts,
71 lungs,
93 livers,
8 liver lobes
and 9 pancreata.
Twenty-four recipients received 2 organs
and 16 received 3 organs
Of the 526 recipients, data were available for 448 recipients who received 495 organs from 177 donors with primary intracranial malignancy
The key observation was that there were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed.
Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers.
4 of the 448 (1%) recipients, was PTLD
Discussion
There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission.
many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculo systemic shunt placement-, and potentially associated with systemic dissemination of tumor cells.
In this study, they were unable to determine the proportion of donors in the data set who underwent such interventions.
small proportion of donors the diagnosis was made solely according to the appearance on cross-sectional imaging in the absence of corroborative histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
When histology was available the reports were not coded by the reporting pathologist and we have no data on whether the histological diagnosis was made before death or at autopsy.
The total number of potential organ donors in the UK who died from primary intracranial malignancy is uncertain,
Equally the number of potential recipients who have died on the waiting list for lack of an organ that could have been provided by such a donor.
What is clear is that guidelines such as those issued by the Council of Europe should not be taken in isolation, but the risk of disease transmission should be balanced against the risk of recipient death without a transplant, a risk that is ever more acute as the gap between the number of available organs and the number of potential recipients widens, in spite of recent initiatives to increase deceased donation rates
In the face of increasing waiting list mortality, it could be argued that the absence of transmission of donor intracranial malignancy in the present UK series reflects an inappropriate degree of clinical conservatism.
selectively declined donors with
intracranial shunts
and previous craniotomy
and or radiotherapy.
In addition, there is an inevitable fear of commission, that is, of actively transplanting an organ that might result in a patient dying as a result of transmitted malignancy.
In contrast, when the surgeon is guilty of omission, that is, of declining the organs from donors with primary intracranial malignancy, they feel less responsible for a subsequent waiting list death and are less culpable in the eyes of the patient’s family.
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including
tumor histology
treatment,
including radiotherapy
and surgery.
examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken,
careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread
Very good but long and despite that no mention of other registries
mai shawky
2 years ago
Summary:
· cadaveric donors with intracranial malignancy were precluded, however the Shortage of donor pool made it essential to investigate the risk of transmission to the recipient.
· The current study found that No risk of transmission was observed among 448 recipients of 495 organs from 177 of these donors were identified, even with high grades, so can be used safely.
· The small risk of transmission (especially after commencing immunosuppressive therapy) should be balanced against the risk of mortality when being on dialysis.
· Debulking surgery, radiotherapy and ventriculosystemic shunt placement, all breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells which can carry a risk of cancer transmission to the recipient
· So, the transplant team:
o Should counsel the recipient about the small, but definite risk of transmission with obtained written consent.
o Should examine the thoracic and abdominal organs for any evidence of dissemination.
o Should examine the craniotomy site, and be aware of the site , grade and histological type of malignancy.
· Both living and cadaveric donors with active malignancy are contraindications for donation due to risk of transmission. However, intracranial malignancy with intact blood brain barrier, low grade tumor and no dissemination is an exception.
The use of organs from donors with primary intracranial malignancy, where the risk of spread outside the CNS, and hence the risk to transplant recipients, is low. Organs from such donors have been used for transplantation over many years, on the basis that disease transmission was rare.
A reliable estimate of the true risk of transmission of an intracranial malignancy is necessary to enable a balanced decision to be made regarding the risks to potential recipients.
Method: Study aim: to quantify the risk of transmission of a primary intracranial malignancy from an organ donor. Data source: fromthe UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors.
UK cancer registries have estimated completeness of registration to be 94% for all malignancies excluding nonmelanoma skin cancer Study period: between 1985 and 2001 Inclusion: donors with a primary intracranialmalignancy.
all recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006, giving a minimum follow-up period of 5 years for all transplant recipients.
Results:
Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
A total of 448 recipients of 495 organs from 177 of these donors were identified.
No transmission of donor intracranial malignancy occurred.
Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers.
The most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD
Conclusion:
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Limitations:
The cancer registries did not record complete data on the treatment of intracranial tumors.
Data were not available on the mode of diagnosis of the tumor (biopsy, craniotomy or autopsy) or only based on the appearance on imaging in the absence of histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
Thankyou for the comprehensive and analytical summary.
MOHAMMED GAFAR medi913911@gmail.com
2 years ago
Potential donors who have active or recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence of metastasis.
An important exception to this rule is the use of organs from donors with primary intracranial malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low .
the Council of Europe in 1997 stated that while the use of organs from donors with low grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
The cancer registries classify tumors according to the WHO 10th ICD, and although data were not available on the mode of diagnosis of the tumor (stereotactic biopsy, craniotomy or autopsy) it is likely that in a small proportion of donors the diagnosis was made solely according to the appearance on cross-sectional imaging in the absence of corroborative histology ,which carries a risk of both under and overestimating the grade of intracranial malignancy .
When potential donors with intracranial malignancy are re- ferred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treat- ment, including radiotherapy and surgery. At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be under- taken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread .
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission .
Donors with primary intracranial malignancy, has the risk of spread outside the CNS, and hence the risk to transplant recipients is small. Organs from Donors with primary intracranial malignancy have been used for transplantation over many years as the risk of getting malignancy is considered none.
A reliable estimate of the true risk of transmission of an intracranial malignancy is necessary to enable a balanced decision to be made regarding the risks to potential recipients.
The Study between 1985 and 2001 aimed to quantify the risk of transmission of a primary intracranial malignancy from Donors with primary intracranial malignancy. The study data was from the UK Transplant Registry and from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors.
UK cancer registries have estimated completeness of registration to be 94% for all malignancies excluding nonmelanoma skin cancer
All recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006, giving a minimum follow-up period of 5 years for all transplant recipients.
The study showed identified 177 of these donors from a total of 448 recipients of 495 organs in which no transmission of donor intracranial malignancy occurred. Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers. The most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumours, should be considered for transplantation and the small risk of tumour transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Study limitation was cancer registries did not record complete data on the treatment of intracranial tumours. Data were not available on the mode of diagnosis of the tumour (biopsy, craniotomy, or autopsy) or only based on the appearance on imaging in the absence of histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumours should not be used because of the perceived high risk of cancer transmission.
The patient should be counselled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting
Introduction
Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients. Exception is use of organs from donors with primary intracranial malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low.
Council of Europe in 1997 stated that while the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
In this study data held on the UK Transplant Registry on transplant recipients and organ donors together with information on new cancers held by the UK national cancer registries is reviewed.
Method
· Retrospective study using data from The UK Transplant Registry
· between 1985 and 2001 including data related to their cancer registry were reviewed.
· From 8 regional cancer registries in England, Northern Ireland, Wales and Scotland, and all record the occurrence and type of every primary malignancy upon diagnosis.
· 179 donors with intracranial malignancy donates organs for 526 recipients and 448 Recipients traceable by cancer registries.
Discussion and conclusion
Donors with intracranial malignancies should be assessed by the surgeons carfully before accepting them . histology and treatment received should be part of important information to get. risk of transmission is higher if patient (donor) undergone interventions such as stereotactic biopsy , debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier.
How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data
Please provide a summary of this article
The objective:
*This analysis to quantify the risk of transmission of a primary intracranial cancer from an organ donor, by studying the incidence of transplanted patients in the UK.
Introduction:
*Transmission of donor-related malignancy by organ transplantation is associated with a lethal outcome in immunosuppressed transplant patient.
*Organs from potential donors who have active or new managed cancer are not considered suitable for transplantation, even when there is no evidence of metastasis; however, organs from donors with primary intracranial malignancy has low risk of transmission. *Council of Europe in 1997 conducted that the use of organs from donors with low-grade primary malignancy was safe,however, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
*Recent analysis from the United States conducted that the rate of disease transmission might be significantly below than previously thought.
*The shortage of donor organs available for transplantation is such that the risks of disease transmission by organs from a donor with primary CNS malignancy have to be balanced carefully against the risk of a potential recipient remaining on the waiting list for transplantation.
The method:
*Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales
and Northern Ireland to identify all organ donors between
1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
The result:
*Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
*A total of 448 recipients of 495 organs from 177 of these donorswere identified.No transmissions of donor intracranial malignancy occurred.
* Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Please provide a summary of this article
Donors with active or recently treated malignancy are declined for donation. However, primary intra-cranial malignancy risk of metastasis outside the CNS is low, so they can be accepted for donation under certain circumstances.
In 1997, the European council stated that organs from donors with high grade malignant CNS tumours especially when the blood brain barrier integrity is compromised should not be considered safe for transplantation.
This is a retrospective study. Data was collected from the UK transplant registry and from the UK national cancer registries.
Aim: assess the transmission risk of primary intra-cranial malignancy from donors’ organs to the recipients.
Study population:
11799 donors from The UK national transplant registry.
179 donors identified with IC malignancy and transplanted to 582 recipients (325 kidneys, 101 livers, 76 hearts, 71 lungs, 9 pancreas).
Results, discussion and recommendations:
None of 177 donors with primary IC malignancy (23 grade IV GA glioblastoma, 9 grade IV medulloblastoma) transmitted the disease to the 448 recipients receiving their organs.
the guidelines should not be taken separately, so the risk of IC malignancy transmission should be balanced against the risk of recipient death while on the waiting list.
In presence of low number of available organs for donation and long waiting list, using organs from donors with primary IC malignancy should be considered.
These results should stress on the co-ordination between organ retrieval surgeons and surgeons transplanting organs to recipients from the same donor whenever a suspicious lesion is identified to allow decision regarding proceeding or not.
risk factors of IC malignancy spread include:
Craniotomy, ventriculo-peritoneal shunts, previous radiotherapy or chemotherapy and longer time between diagnosis and death.
on organ retrieval, proper examination and assessment of organs to rule out any metastasis.Pre-transplantation counselling is of utmost importance discussing pros and cons of proceeding with this donation offer.
This retrospective study involved assessment of national cancer registry data of England, Wales and Northern Ireland, and UK transplant registry data with respect to organ donation from patients dying of intracranial malignancies and risks of tumor transmission form the donor to recipient. The data from 1985 to 2001 was collected and occurrence of recipient cancers was recorded till 2006 (with a minimum of 5 years follow-up).
Out of 5934 donors with linkage to the cancer registries, 227 donors had invasive cancers, out of which 179 had intracranial malignancies. 526 recipients received organs from the 179 donors, out of which 448 were traceable by cancer registries.
32 donors with high grade CNS tumors provided organs to 85 recipients.
None of the recipient developed intracranial malignancy. Only 10 recipients developed non-skin invasive malignancy, with PTLD in 4 of them.
Australia and New Zealand registry showed no transmission while the UNOS data showed that the risk of GBM transmission form donor to recipient is very low (1.7%). The Israel Penn International Transplant Tumor registry (IPITTR), on the other hand showed increased risk of transmission (30-40%). The risk factors for spread include ventriculo-systemic shunts, prior radiotherapy or chemotherapy, increased time between tumor diagnosis and death, stereotactic biopsy, craniotomy and major resection.
The results of the study reassured that the risk of transmission of primary CNS neoplasm from donor to recipient is very low (including for high-grade tumors), and the risk of transmission should be balanced against the risk of dying on dialysis in absence of receiving a transplant. The prospective recipient should be counselled accordingly.
Limitations of the study: Retrospective study, data regarding time of histological diagnosis (whether before transplant, or after transplant) not available, lack of criteria for diagnosing the tumor, and lack of data regarding death while awaiting transplant versus death due to malignancy transmitted from a donor.
This retrospective study analyzed the different tumors and rate of transmission from patients in countries( UK registry).
It has included all organ Tx from 1985 to 2001 having primary intracranial tumor and its transmission to recipient. there is conflicting report across the registry, there is small absolute risk of primary CNS malignancy in the recipient with other organ from donor with high rate of malignancy. According to Council of European guidelines organ from donors with high -grade tumors should not be used because of the risk of tumor transmission.
Brain death due to potential intracranial malignancy represents an important source of organs from donors after brain death….However there is a perceived risk of cancer transmission after the organ donation which is not clear …..
this study reviewed the list of tumor transmission from patients in the United Kingdom, Ireland, south wales.. they included all organ transplant recipients between 1985 and 2001 with inclusive of primary intracranial malignancy and studied the occurrence of post transplant malignancy in the recipient…
Transmission of donor related malignancy is a well known entity and transmission of malignancy from the donor to the recipient always has been a concern….Infact Donors with active malignancy are contraindicated from organ donation… The only exception to this rule is primary intracranial malignancy where the disease spread outside the CNS is very rare…Low grade tumors are not associated with disease spread whereas high grade gliomas where the integrity of the blood brain barrier is compromised was associated with donor cancer transmission….An advice from the council of Europe in 1997 showed that low grade primary brain tumors are safe for organ donation after Brian death and to avoid organ donation from high grade blastomas…This study was undertaken to quantify the risk and create awareness among more brain death organ donation among Primary CNS malignancy
179 patients had intra cranial cancer from which 582 organs were transplanted into 562 recipients….448 recipients could have their data analyzed and were published…No record on recipient intra cranial malignancies were seen from donor primary intracranial malignancy….10 patients had developed non skin malignancies after transplant and it included the most common post transplant lymphoproliferative disease with non Hodgkin’s lymphoma being the commonest…
This data from UK registry which was a retrospective analysis showed that organ donation from the donors who had even high grade glioblastomas or medulloblastoma also did not have increased rate of intracranial malignancy transmission….This finding was new as compared to older case reports of breach in the blood brain barrier with high grade tumors….
this data is in contrast to the Israel Transplant Penn Registry which report 40% donor transmission of glioblastoma multiforme and Grade III glioma transmission of 30%…
Given the conflicting reports across the registry, It is suggested that there is a small absolute risk of Primary CNS malignancy in the recipient with organs from donors with high grade malignancy…an informed consent should be taken to the recipients and if they accept we can go ahead rather than waiting eternally on hemodialysis….A knowledge of the tumor histology, the details of the chemotherapy and radiotherapy, role of stereotactic biopsy, inspection for peritoneal metastasis and epineural invasion of spinal cord will help us to decide, if the organ needs to be harvested…We should avoid organs from these advanced tumors as the spread rate is very high
-Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients
-When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
-At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation
*This retrospective study has been shown that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs.
8There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
* According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission
the patient should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting
Organ shortage is becoming a real issue in world of transplantation and all efforts are made to expand the donor pool , considering primary CNS tumor donors is such an attempt.Caution is needed while making such decisions. The fact that primary CNS tumors do not metastasize unless blood brain barrier is compromised is the most important question while making such decisions.
The authors of this study have tried to look into their local data to see outcome of such donation.
Materials and Methods
Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors be- tween 1985 and 2001 inclusive with a primary intracra- nial malignancy and to identify the occurrence of post- transplant malignancy in the recipients of the organs transplanted.
Of 11 799 organ donors in the study period.
179 were identified as having had a primary in- tracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblas- tomas).
A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
1. Please provide a summary of this article
Introduction:
Donors with malignancy are usually not accepted because of fear of transmission. However, risk of transmission of malignancy from primary intra cranial malignancy is rare. So, donors dying from intra cranial malignancy is an important source of organs.
In this study UK transplant registries combined with cancer registries were evaluated to find out the incidence of cancer transmission.
Materials and Methods
Donors from 1985-2001 were identified, their names and other important information were sent to UK cancer registry to find out any diagnosis of malignancy at time of donation or in the past. Recipient of organs from these donors were identified and followed till end of 2006, to find out any transmission of malignancy.
Results
Out of 5934 donors, 227 were identified as having one malignancy at least.
179 of these has intra cranial malignancy. None of them transmitted the disease
There is definite risk but small.
Conclusion:
Donor with malignancy can be considered after counselling the recipient and excluding high risk and metastatic ones.
· The use of organs from donors with primary intracranial malignancy, where the risk of spread outside the CNS, and hence the risk to transplant recipients, is low
· Council of Europe in 1997 considered organs from potential donors with high-grade malignant tumors of the CNS, unsafe for transplantation
· A recent analysis from the United States suggests that the incidence of disease transmission might be significantly lower than previously thought
· This study aim to quantify the risk of transmission of a primary intracranial malignancy from an organ donor
Materials and Methods
· demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001
· There are eight regional cancer registries in England, together with separate registries for Northern Ireland, Wales and Scotland
· Data were collected from histopathology laboratories, radiotherapy, chemotherapy and surgical units and from multidisciplinary site-specific cancer team meetings
· The records of all organ donors in the UK held on the UK Transplant Registry were identified and demographic information forwarded to each of the 10 participating cancer registries
· Using this information, all recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries
Results and Discussion
· No one of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs
· many donors with high-grade tumors, who provided organs for 85 traceable recipients
· The data here the same as the result of large study by UNOS, as only a GBM transmitted to 1.7% of recipients, with the organs were from 1 donor
· Other smaller series from transplant registries have also suggested the risk of transmission of donor intracranial cancer is small
· The Australia and New Zealand registry reported no cases of transmission in 96 recipients of organs from 28 donors with malignant primary brain tumors
· Data from Czechoslovakia showed no transmission of 11 high-grade tumors to 27 recipients, and a report from Spain also failed to demonstrate a case of transmission of organs from 9 donors with GBM.
· The occurrence of extraneural metastasis from intracranial tumors is rare, even from high-grade tumors like GBM where vascular invasion is a diagnostic feature
· Risk factor for extraneural metastasis of brain tumors:
1- Craniotomy and major resection
2- stereotactic biopsy
3- ventriculosystemic shunts
4- prior radiotherapy or chemotherapy
5- an increased time between diagnosis of tumor and death
· When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery
· any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
Transmission of donor-related malignancy by organ transplantation is a well-recognized and often fatal complication in immunosuppressed transplant recipients.
So patients with active malignancy or treated recently are not suitable for organ donation even if no metastasis.
But donors with primary intracranial malignancy can donate organs, because the risk of spread outside the central nervous system is low and thus to the transplant recipients is also low.
However, there have been case reports of recipients where transmission of malignancy has occurred from donors with primary malignancy of the central nervous system. These cases typically involve high-grade malignant tumors in donors who have undergone
interventions that compromise the blood brain barrier and this regarded as a risk for spread outside the central nervous system.
The increasing demand and shortage of donor organs available for transplantation, make donation from a donor with primary CNS malignancy to be balanced carefully against the risk to be in a waiting list.
At present in the UK, for example, around 1 in 5 patients awaiting lung or liver transplantation dies on the waiting list.
So definite estimation of the true risk of transmission
of an intracranial malignancy is necessary for balanced
decision regarding transplantation risks to the potential
recipients.
This study is done to quantify the risk of transmission of a primary intracranial malignancy from an organ donor .
The data are collected from the UK Transplant Registry
on transplant recipients and organ donors together with information on new cancers held by the UK national cancer registries.
There are eight regional cancer registries in England, together with separate registries for Northern Ireland, Wales and Scotland, and all record the occurrence and type of every primary malignancy upon diagnosis (although some registries do not record data on basal cell carcinomas of the skin) and additional data such as patient death rate.
For this analysis, information from the eight English and the Welsh and Northern Irish Registries were
available for interrogation. Information from the Scottish registry was not obtainable and consequently data were not available on around 10% of UK organ donors or on recipients living in Scotland.
The Cancer Registries coded intracranial malignancy on the basis of available histology and/or other relevant information such as cross-sectional imaging according to the 10th World Health Organization International Classification of Disease (WHO ICD-10).
The result of this retrospective study of UK registry data is that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipient who received their organs only 10 recipients developed a new non-skin invasive malignancy .
Many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
The Council of Europe guidelines states that organs from donors with high-grade brain tumors should not be used.
Because of the deficiency the cancer registries regarding the treatment of intracranial tumors, the authors are unable to define the donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculo-systemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells .
This study has more or less the same result with the only other large study from the United Network for Organ Sharing in the United States and reported the outcome of 642 recipients of organs from donors with primary intracranial tumors.
It included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred to three recipients (1.7%) of organs from one donor with a GBM . The donor had a 2-year interval from diagnosis to death, he underwent a stereotactic biopsy.
A completed course of whole brain irradiation was done
followed 1 month later by a fatal intracranial hemorrhage.
Metastatic GBM was noted in a lymph node at the time
of bilateral lung transplantation.
Transmission also occurred to the recipients of the liver and one kidney.
This particular case also emphasizes the need immediately notify other implanting teams of the same donor.
Precautions :
So when potential donors with intracranial malignancy are referred, it is essential that relevant information, including tumor histology and treatment, including radiotherapy and surgery should be known.
Also examination of the thoracic and abdominal cavities for metastatic tumor should be done as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extra-neural spread.
Finally the potential recipients for transplantation from donors with intracranial malignancy should be counseled regarding the small but definite risk of transmission, as well as their risk if they remain on the waiting.
1. Please provide a summary of this article
Summary of the article.
Cancer and organ transplant have been a concern to the potential recipient due to the possible high risk of passing the same to the recipient. The article deals with deceased donors with primary intracranial malignancy if there is a risk of tumor transfer from donor to recipient.
The article aim focuses on the risk of possible tumor transmission by reviewing the incidence in patients that were transplanted in the UK.
The source of the investigation was taken from the UK Transplant Registry and from other sources from different cancer registries like England, Wales, and Northern Ireland from a period of 1985 to 2001. This inclusively includes primary cancer intracranial and how it affects the recipient post-transplant.
Based on what was obtained from the study the following results were documented.
1) There were a total of 11799 donors registered on the national transplant registry of which 179 were identified as having intracranial malignancy.
2) From the 179 donors with intracranial malignancy 582 organs were harvested. 325 were kidneys, 101 livers, 76 hearts, 71 lungs, and 9 pancreas.
3) From the 179 donors, there were 526 recipients of which some received two organs.
4) From the 526 recipients, 448 recipients were traceable by cancer registries, also some of the recipients had more than one organ transplanted.
5) Now from the 448 recipients traceable by the cancer registries, 10 of the recipients developed a new non-skin invasive malignancy and the remaining has no transmission of intracranial malignancy.
Based on European guidelines, high-grade tumors must not be used for donation due to the high risk of transmission. The risk of transmission increases with intracranial intervention. In a study conducted in the United States, there were 642 recipients of which, 1.7% of the recipients had transmission. In some other small studies, there was no form of transmission.
So in conclusion, there was no malignancy found from donors to recipients of intracranial tumors. However, proper investigations must be carried out to ensure there is no metastasis. Once a recipient is to receive a donation for a donor who is at low risk, the recipient must be informed and explained all the possible complications.
In general, there is a risk of transmission of donor-related malignancy by organ transplantation and in immunosuppressed transplant recipients. It’s often a fatal complication. So, organs from potential donors who have active or recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence of metastasis. However, there´s the exception for this one, which is the case of primary intracranial malignancy. This kind of malignancy is unusual.
For this study, demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001 in UK Transplant Registry and cruzed with information from the eight English and the Welsh and Northern Irish Registries. So , of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer, from whom 582 organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes and 9 pancreata. The key observation was that there were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed. Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers. As might be expected the most common type of malignancy which occurred in 4 of the 448 (1%) recipientes was posttransplant lymphoproliferative disease (PTLD).
Some centers in the world (United States, Australia, New Zealand and Spain) have a record of cases of GBM transmission to Kidney Transplant recipients and although there are few cases for analysis, it is possible to say that even small, but the risk of transmitting cancer is certain. from donors with primary intracranial malignancy.
Introduction:
Organ transplantation in donors with malignancy is contraindicated, with exception to
patient with primary brain malignancy where the risk is low. Organs from such donors
have been used for transplantation over many years, on the basis that disease
transmission was rare.
In order to quantify the risk of transmission of a primary intracranial malignancy from an
organ donor, we collated data held on the UK Transplant Registry on transplant
recipients and organ donors together with information on new cancers held by the UK
national cancer registries.
Materials and methods:
demographic information on both donor and recipient for organ transplants undertaken
between 1985 and 2001 inclusive, together with details of the organs transplanted were
reviewed.
Results:
5934 donors with the appropriate information to allow linkage to the cancer registries,
227 donors were identified as having at least one cancer, Of the 227 donors who had an
invasive malignancy, 179 had an intracranial cancer from whom 582
organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs,
93 livers, 8 liver lobes and 9 pancreas.
Twenty-four recipients received 2 organs (pancreas and kidney, liver and kidney, double
lung or double kidney), and 16 received 3 organs.
there were no recorded cases of transmission of intracranial malignancy to any of the
448 transplant recipients whose data could be analyzed.
Only 10 recipients were recorded as developing malignancy following transplantation,
excluding those who developed primary skin cancers. As might be expected the most
common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD.
Discussion:
that none of the 177 donors with primary intracranial malignancy transmitted the
malignancy to the 448 recipients who received their organs. There were many donors
with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM)
and 9 with medulloblastoma who provided organs for 85 traceable recipients.
When donors with intracranial malignancy is referred transplantation, the surgeon should
be aware of all the relevant information, including tumor histology and treatment,
including radiotherapy and surgery.
At the time of organ retrieval, a thorough examination of the thoracic and abdominal
cavities for metastatic tumor should be undertaken, as well as careful assessment of any
craniotomy site and related lymph nodes for evidence of extra neural spread; if found,
and confirmed histologically, the organs should probably not be considered for
transplantation.
Finally, it is important that any patient being considered for transplantation where
organs from donors with intracranial malignancy may be used, should be counseled
regarding the small but definite risk of transmission of malignancy.
Aim:
Study design:
Results:
Conclusion:
Summary:
Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, the perceived risk of tumour transfer to the organ recipient has limited their use.
Aim: To evaluate the risk of tumour transmission by reviewing the incidence in patients transplanted in the UK.
Methods:
Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
Results:
Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor intracranial malignancy occurred.
Conclusion:
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumours, should be considered for transplantation and the small risk of tumour transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
In this retrospective study published in 2010, 582 organs were retrieved from 179 donors. 495organs transplanted from 177 donors (279 kidneys, one combined liver-kidney, 1 double kidney, 51 hearts, etc). The study evaluated patients between the years 1985-2001). With limited data about all cases in terms of applied treatmentsno recipient has brain tm. Cancers occurred in recepients were NLH, lung, bladder, breast etc. as detailed in table 2. In this context the risk of recurrence of brain tumors of low incidence should not discourage, rather should be weighed against continuing on dialysis. malignancies post transplantation may occur even in recepients with unknown previous maligncies.
Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, a perceived risk of tumor transfer to the organ recipient has limited their use.
Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients .
As a result, organs from potential donors who have active or recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence of metastasis.
An important exception to this rule is the use of organs from donors with primary intracranial malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low.
the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission .
In addition, many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells.
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation.
Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list.
Please provide a summary of this article
-Transmission of donor-related malignancy by organ transplantation is a well recognized and often fatal complication in immunosuppressed transplant recipients . As a result, organs from potential donors who have active or
recently treated malignant disease are not normally considered suitable for transplantation, even when there is no evidence ofmetastasis. An important exception to this rule is the use of organs from donors with primary intracranial
malignancy, where the risk of spread outside the central nervous system, and hence the risk to transplant recipients, is low. Organs from such donors have been used for transplantation over many years, on the basis that disease transmission was rare.
-There have been case reports of recipients where transmission of malignancy has occurred from donors with primary malignancy of the central nervous system. Since such cases typically involve high-grade malignant tumors in donors who have undergone interventions that compromise the blood brain barrier, a more selective policy for use of organs from donors with primary brain malignancy has emerged.
– Advice from the Council of Europe in 1997 stated that while the use of organs from donors with low-grade primary malignancy was safe, organs from potential donors with high-grade malignant tumors of the CNS, especially where the integrity of the blood brain barrier is compromised, should no longer be considered safe for transplantation .
-It is retrospective study of UK registry data .
– Donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially
associated with systemic dissemination of tumor cells .
-Other smaller series from transplant registries have also suggested the risk of transmission of donor intracranial cancer is small, although the numbers of high-risk donors reported, such as those with GBM or medulloblastoma, were very small.
-The study data are very reassuring, there remains a small but definite risk of transmitting cancer from donors with primary intracranial malignancy. The occurrence of extraneural metastasis from intracranial tumors is rare, even
from high-grade tumors like GBM where vascular invasion is a diagnostic feature . Craniotomy and major resection is a risk factor for extraneural metastasis of brain
tumors and, to a lesser extent, so is stereotactic biopsy following which tumor seeding down the needle track has been observed . Following craniotomy metastasis often manifests with infiltration around the craniotomy site, or in the ipsilateral jugular lymph nodes.
– Other factors reported to increase the risk of extraneural spread, and donor cancer transmission, include ventriculosystemic shunts, prior radiotherapy or chemotherapy, and an increased time between diagnosis of tumor and death.
-About half of all intracranial tumors are not primary brain tumors, but represent secondary spread from an extraneural primary and these pose an unacceptably
high risk of disease transmission
-When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
-At the time of organ retrieval a thorough examination of the thoracic and
abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs
should probably not be considered for transplantation.
-It is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their
chance of survival if they choose to remain on the waiting list .
Introduction
The number of recipients on the waiting list is increasing as is the time to receive the transplant. This is due to the reducing pool of deceased donors. Donors with malignancies are disqualified from donating. Transplant centers are also shying away from utilizing donors with primary intracranial malignancies. This was a retrospective survey that looked at recipients who got organs from donors with primary intracranial malignancies
Methodology
Data was obtained from the UK registry for all donors utilized during the time period of 1985-2001.
Demographic data for 11,799 donors from the UK transplant registry from 1985-2010 was forwarded to the 10 participating UK cancer registries.
227 donors were identified as having at least one cancer from which 179 had a primary intracranial malignancy. Out of the 179 donors who had a primary intracranial malignancy, 33 had a high grade malignancy. 526 recipients received organs from these donors. Data was only available for 448 recipients.
Results
There was no transmission of intracranial malignancy that occurred in the recipients.
The data presented here are reassuring and are in agreement with the only other large study which is from UNOS in the U.S and reported the outcomes of 642 recipients of organs from donors with primary intracranial tumors. The series included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred in 3 recipients.
The cancer registries classify tumors according to The Who 10th ICD, and although data were not available on the mode of diagnosis of the tumor, it is likely that in a small proportion of donors the diagnosis was made solely on the appearance of cross-sectional imaging with no corroborative histology
Conclusion
This study demonstrates that organs from donors with primary intracranial malignancies can be safely transplanted as long s it is not a high grade tumor, it is not a recurrence, no surgical interventions like debulking or ventriculosystemic shunting or radiotherapy was done
When potential donors with intracranial malignancy are referred, it is essential that the surgeon should be aware of all the relevant information including tumor histology, and treatment including radiotherapy and surgery. At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken as well as careful assessment of any craniotomy site and related lymph nodes for any evidence of extra-neural spread
This article is retrospective study focus on transmission of donor primary intracranial malignancy to transplant kidney.
This study done between 1985 and 2001 includes cases with a primary intracranial malignancy and to identify the occurrence of post transplant malignancy in the recipients of the organs transplanted.
The primary intracranial malignancy including with high-grade malignancy of gliomas and medulloblastomas).
This study shows No transmission of donor intracranial malignancy occurred.
Transmission of donor related malignancy by organ transplantation is serious fatal complication in immunosuppressed transplant recipients. So organs from donors who have active or recently treated malignant disease are not considered suitable for transplantation, even when there is no evidence of metastasis.
But there’s exception for donors with primary intracranial malignancy, where the risk of spread outside the central nervous system low. Organs from such donors can be used for transplantation over many years, on the basis that disease transmission was rare.
Donors with low grade primary malignancy was safe.
Donors with high grade malignant tumors of the CNS where the integrity of the blood brain barrier is compromised, should no considered for transplantation. The incidence of disease transmission might be significantly lower than previously thought.
The shortage of donor organs available for transplantation is the cause to consider risks of disease transmission by organs from a donor with primary CNS malignancy studied carefully against the risk of recipient remaining on the waiting list for transplantion.
Demographic data collected from
Cancer registries in the UK and it’s population-based and collect data from histopathology laboratories, radiotherapy, chemotherapy and surgical units and from multidisciplinary site specific cancer team meetings.
this study shows no development of cancer fallow transplant in patients received kidney donor with primary intracranial malignancy but very few of them develop posttransplant lymphoproliferative disease.
the key observation of cases there’s no transmission of intracranial malignancy to any of the selected cases of transplant recipients whose data was analyzed.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission. Many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cell. There’s no complete data on treatment of primary intracranial tumors in donor.
Death from primary intracranial tumor in donor was uncertain and Metastatic glioblastoma was noted in a lymph node at the time of bilateral lung transplantation. this was transferred to recipient liver and one kidney. This study advice to decline donors with intracranial shunts and previous craniotomy and or radiotherapy. It’s less act of commission where as recipient with malignant donor die fallow transplant may claim it mis related to transmission of malignant donor.
It’s should be counselling any recipient with malignant donor there is very little risk of transmission of primary intracranial cancer.
Donors with active malignancy or recently treated malignancy are excluded from donation because of the risk of transmission of malignancy to the recipient, on the other hand, patients with primary intracranial malignancies are accepted for donation as the risk of transmission is low, also, the increased demand for organ donors forced to accept unsuitable potential donors with intracranial malignancy.
However, case reports of transmission of malignancy to recipients were reported in donors with high grade malignancy and more selective policy was approached.
The risk of transmission of intracranial malignancy should be balanced against the risk of remaining on waiting list for transplantation.
This retrospective study aimed to evaluate the risk of transmission of primary intracranial malignancy from organ donor.
It analyzed information from UK transplant registry and national cancer registries, 179 organ donors had a primary intracranial malignancy and 448 recipients of 495 organs were included.
The study showed that none of the donors transmitted malignancy to the 448 recipients including donors with high grade tumors.
Although the results were reassuring, there was a definite small risk of cancer transmission from donors with primary intracranial malignancy, the risk of extra-neural transmission is rare but increases with high grade tumors, craniotomy, major resection, chemotherapy, radiotherapy and increased time between diagnosis and death,
Any patient considered for transplantation from a donor with intracranial malignancy should be counseled about the risk of malignancy transmission and the risk of remaining on the waiting list.
this article focuses on the saftey of using organs from patients who have primary brain malignancy and the risk of tranrnsmision to the recipent,
This retrospective study of UK registry data has shown that none of the 177 donors with primary intracranial malignancy transmitted the malignancy to the 448 recipients who received their organs. There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients,
the study shows No transmission of intracranial malignancy ,
Summary
This article is about the usage of organs from deceased donors with primary intracranial malignancy. Although a small risk of malignancy can be transferred to the recipient, the given study has found no evidence of such. The authors of this study thus recommend the acceptance of deceased organ donors even if they have high grade primary CNS malignancies with a small risk of transfer to recipient, keeping in view the risk of malignancy if the recipient remains chronically on the waiting list.
Factors that can determine increased risk of cancer transmission to recipient from such donors include :
It is important for the surgeon to be aware of tumor histology and treatment, radiotherapy and prior surgery before accepting the donor. Examination of thoracic and abdominal cavities is very important. Lymph nodes need to be checked, and if there is evidence of spread here then the organ is recommended not to be considered for transplantation.
Recipient counseling is very important before proceeding for transplantation – the small but definite risk of cancer transmission. Full information should be given about consequences in case the recipient refuses the donor and chooses to remain on the waiting list for a longer period of time. This can lead to increased risk of mortality.
Malignancy was always the main impediment for donating an organ , instigated from the fear that transplanting an organ from a donor with malignancy might transfer the same malignancy to the recipient with the mounting risk integral to the immunosuppressed status of the recipient. Therefore , the transplant guidelines have revoked the donation from a malignancy donor, and set a time frame for donation relative to each type of malignancy after squared remission.
The story is different with intra cranial malignancy as its inherently metastasize locally with no distant or systemic metastasis. Nevertheless, few anecdotal reports elucidated the occurrence of distant metastasis secondary to transplanting organs from donors with intra-cranial malignancy.
To test this proposition , this retrospective study was conducted in UK from UK transplant registry kept in NHS along with UK cancer registry data, by reviewing the the records of organ transplant recipients conducted between 1984 and 2001.
179 donors were identified as having primary intracranial tumors . 33 of them were high grade malignancy (grade IV glioma and Medulloplastoma).
The entire recipients were 448 for 495 organs from 177 donors.
This study concluded , that there is no reported transmission of malignancy to any of the recipients in this cohort. Which is in agreement with several other studies that concluded the same .
Organs from active malignancy or recently treated malignant disease are not suitable for transplantation , exception is primary intracranial malignancy. However, there are case reports where transmission of malignancy occurs from donor with primary intracranial neoplasm.
This retrospective study was done to evaluate the risk of tumor transmission from a donor with a primary intracranial malignancy.
Information obtained from UK Transplant registry combined with from the national cancer registries of England, WAles and Northern Ireland between 1985 and 2001.
Among 11799 patients, 179 were identified having primary intracranial malignancy including 24 grade IV gliomas and 9 medulloblastomas.
No transmission of donor intracranial malignancy occured.
In conclusion , primary intracranial malignancy patient can be accepted as potential donor with some risk of transmission.
What are the risk factors to be avoided
Please provide a summary of this article
Introduction
Active or recently treated malignancy is an absolute contraindication of transplantation
Primary intracranial malignancy may be an exception as the risk of transmission is low
Despite that transmission occurred in many cases with high grade malignancy with intervensions that involve the BBB
Aim of the study
Retrospective study of UK registry data to identify the incidence of primary intracranial malignancy from an organ donor
Materials and Methods
Both donors and recipients in UK were include (1985 and 2001)
Data from the UK Transplant Registry, the national cancer registries of England, Wales and Northern Ireland Donors and recipients
Results
From the 11799 Donors, 179 had an intracranial malignancy (donated 582 organs to 526 Recipients)
The 179 donors including high grade tumours:
Grade IV gliomas (n=23)
Medulloblastoma (n=9)
No any transmission of malignancy from donors of intracranial malignancy
Discussion
According to the Council of Europe guidelines, high grade tumours should not be used for donation as the risk of tramsmission is high. The risk increases with intervensions
No complete data for treatment of intracranial tumours (intervensions that breach the BBB may be missed)
No data for how tumours was diagnosed (may relied only on imaging and no histology)
This data agreed the large study of the United Network for Organ Sharing in the United States. They studied 642 recipients of organs from donors with primary intracranial tumors (175 recipients where the donor tumor was a GBM). Transmission occurred to three recipients (1.7%) of organs from one donor with a GBM
In other small studies, no transmission
In the IPITTR, 34 organs from donors with high- grade gliomas (4 grade III, 30 grade IV), 25% incidence of transmission from organ donors with grade III gliomas and 40% transmission from donors with GBM
This data although reassuring, it is small
At the time of retrieval, examination in details is paramount to look for any possible transmission of malignancy
Conclusion
No malignancy transmission of donors with intracranial malignancy
Donors with intracranial malignancy including those with high grade toumours should be considered
The small risk of transmission should be balanced with long waiting list of organ transplant and adverse outcome
The IPITTR information was accused of over recording bias the results are therefore overlooked.
Intracranial primary tumors in organ donors were not considered as a contraindication for donation. The Council of Europe guidelines stated that high-grade brain tumors patients should not donate their organs . Those donors carry high risk of transmission of their cancer plus they have gone through interventions that might disrupt blood brain barriers with dissemination of malignant cells systemically. Recently some reports have contradicted this. This is a retrospective analysis of UK registry data between 1985 and 2001. The aim of this study is to quantify the risk of transmission of a primary intracranial malignancy from an organ donor. 179 out of 11799 organ donors had a primary intracranial malignancy ( 33 with high-grade malignancy) . They donated their organs to 526 recipients and the researcher found the data of 448 recipients (495 organs).
Only 10 patients developed malignancy after transplantation. No transmission of donor intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation. The possible risk of tumor transmission should be weighed against the likely mortality from being remained on the transplant waiting list.
Very good
This is a study that cross-references information from UK transplant and cancer registries in an attempt to establish whether malignant brain neoplasms have the potential to be transmitted from donor to recipient of solid organ transplants. Currently, potential donors with malignant neoplasm of the central nervous system are unable to complete the procedure.
Data were collected in a retrospective cohort from 1985 to 2001 with 11,799 donors and crossing the data with ten cancer centers obtaining data from 5934 patients, where 179 had central nervous system neoplasm, where 23 had glioblastoma multiforme and 9 medulloblastomas.
Most post-transplant neoplasms are related to PTLD, with no primary CNS disease involved. With the dwindling availability of deceased donor organs, there is a need not to restrict supply unnecessarily. Situations such as aggressive disease with metastasis or lymphatic or vascular invasion, ventricular shunts, and radiotherapy could be considered when not accepting the organ for donation.
To minimize the risk of transmission of malignancy in these situations, a thorough examination of the thoracic and abdominal cavities in an attempt to find metastases or lymph node enlargement to suspend the donation process.
This study suggests that potential patients to donate an organ should not be automatically excluded when having a diagnosis of central nervous system neoplasm, individualizing the choice process on a case-by-case basis depending on the invasiveness and expansion of the disease.
Well done
Provide summery of the article
Because of scarcity of organ donation we might accept some donors with risk like donor with primary intracranial tumors ,as we are weighing whether to keep the recipient on dialysis or take organ with very low risk according to the recent EBM,
As all recents data denotes that all primary intra cranial tumor which is very localized and not invade the BBB or did surgical intervention like shunt has very low risk to be metastesized .
this study was a retrospective analyzing data for the UK register data
found that 177 donors gave their organs to the 448 recipients ,No one of the recipient developed malignancy and most of them were quiet well .another two study were held in US and Australia both of them consolidated that there is no risk of transmission from the donor with primary IC cancer and even among those with advance stages .
These data should be taken with consideration that donors with IC shunts, craniotomy
&/or radiotherapy are likely to have been selectively declined.
·On organ retrieval all body cavities should be well examined for any evidence of
metastatic tumor as well search for any craniotomy site & related lymph nodes for
evidence of spread.
·Patients should be counseled about the small but definite risk of transmission, & also
chance of survival if they choose to remain on the waiting list.
Well done
The occurrence of extraneural metastasis from intracranial tumors is rare, even from high-grade tumors like GBM where vascular invasion is a diagnostic feature
Craniotomy and major resection is a risk factor for extraneural metastasis of brain tumors
Following craniotomy metastasis often manifests with infiltration around the craniotomy site, or in the ipsilateral jugular lymph nodes. Other factors reported to increase the risk of extraneural spread, and donor cancer transmission, include ventriculosystemic shunts, prior radiotherapy or chemotherapy, and an increased time between diagnosis of tumor and death.
It is important to note that about half of all intracranial tumors are not primary brain tumors, but represent secondary spread from an extraneural primary and these pose an unacceptably high risk of disease transmission
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including:
tumor histology and treatment,
radiotherapy and surgery.
At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread;
if found, and confirmed histologically, the organs should probably not be considered for transplantation.
Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
Very good
1. Please provide a summary of this article
Introduction
·Generally, organs from donors with active or recently treated malignancy are not suitable for donation; however, primary IC malignancy is an exception to this rule as the risk of metastasis outside the CNS, & thus the risk to recipients, is low.
·The Council of Europe in 1997 stated: “while the use of organs from donors with low-grade primary malignancy is safe, organs from donors with high-grade malignant tumors of the CNS, (especially where the integrity of the BBB) is compromised, should not be considered safe for transplantation.”
·A recent analysis from the US reports that the incidence of transmission might be markedly lower than previously thought.
·Due to the shortage of donor organs the risks of disease transmission from a donor with primary CNS malignancy is to be carefully balanced versus the risk of potential recipients remaining on the transplant waiting list.
The study
Aimed to quantify the risk of transmission of primary IC malignancy from an organ donor from data on the UK Transplant Registry for transplant recipients & organ donors & data on new cancers from the UK national cancer registries.
Flow chart of the study:
·Donors on national transplant registry: 11799:
–5827 with NHS number on UK Transplant Registry
–107 idenitified via NHS STS.
–5865 with no NHS number & not found by NHS STS
·179 Donors identified with an IC malignancy, & transplanted to:
–582 (325 Kidneys, 101 Livers (whole or lobes), 76 Hearts, 71 Lungs, & 9 Pancreas).
·526 Recipients:
18 recipients from Scotland (12 kidneys, 3 livers, 3 hearts)
60 recipients have insufficient data to trace
4 heart-lung, 1 double lung, 6 hearts, 1 single lung, 23 kidneys, 25 livers (inc.1 lobe)
·448 Recipients (out of 526) traceable by cancer registries:
495 Organs transplanted from 177 donors
279 Kidneys
1 Double kidney
72 Liver (65 whole, 7 lobes)
1 Liver + kidney
12 Heart + double lung
13 Double lung
51 Hearts
10 Single Lungs
8 Pancreas + kidney
1 Solitary pancreas
·10 Recipients subsequently developed a new non-skin invasive malignancy:
No transmission of intracranial malignancy
Discussion
·This retrospective study of UK registry data shows that none of 177 donors with primary
IC malignancy transmitted the disease to the 448 recipients who received their organs.
·Many donors had high-grade tumors (23 grade IV GBM & 9 with medulloblastoma who
provided organs for 85 traceable recipients).
·The number of potential organ donors in the UK who died from primary IC malignancy is
unknown.
·It is also difficult to quantify the number of potential recipients who have died on the
waiting list for lack of an organ that could have been provided by such a donor.
·Guidelines issued by the Council of Europe not be taken separately, but the risk of
disease transmission should be balanced versus the risk of recipient death without a
transplant.
·Because of the reduction in the number of deceased organ donors, there is a tendency
to consider using organs from potential donors that previously have been deemed
unacceptable, e.g. donors with a H/O IC malignancy.
·The results of this study are reassuring.
·In agreement with this study, the only other large study (from UNOS in the US) reported
the outcome of 642 recipients of organs from donors with primary IC tumors. It included 175 recipients where donor tumor was a GBM & the only transmission was in 3 recipients (1.7%) of organs from 1 donor with a GBM.
·This indicates the need for the surgeons implanting an organ to notify the surgeons
implanting other organs from the same donor whenever they identify a suspicious
finding so to allow a timely decision to be taken whether to proceed or not.
·The Australia & New Zealand registry reported no cases of transmission in 96 recipients
of organs from 28 donors with malignant primary brain tumors, including 4 with GBM.
·Despite these reassuring data, there is still a small but definite risk of transmitting
cancer from donors with primary IC malignancy. Extraneural metastasis from IC tumors
is rare, even from GBM where vascular invasion is diagnostic.
·Craniotomy & major resection is a risk factor for extraneural metastasis of brain tumors.
·Other factors for extraneural spread cancer transmission are:
-Ventriculosystemic shunts
-Prior radiotherapy or chemotherapy
-Increased time between diagnosis of tumor & death.
· These data should be taken with consideration that donors with IC shunts, craniotomy
&/or radiotherapy are likely to have been selectively declined.
·On organ retrieval all body cavities should be well examined for any evidence of
metastatic tumor as well search for any craniotomy site & related lymph nodes for
evidence of spread.
·Patients should be counseled about the small but definite risk of transmission, & also
chance of survival if they choose to remain on the waiting list.
Exellent.
Summary of the article
How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data
This is a retrospective study of the UK transplant registry/NHS in the period between 1985 and 2001 inclusive, together with details of the organs transplanted were reviewed. 11,799 deceased organ donors were notified to the UK Transplant Registry, Of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer, from whom 582 organs were transplanted into 526 recipients, including 325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes and 9 pancreata. Of the 526 recipients, data were available for 448 recipients who received 495 organs from 177 donors with primary intracranial malignancy
Study Result and outcome
1. There were no reported cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed.
2. The risk of transmission of donor intracranial cancer is small.
3. Factors reported to increase the risk of extraneural spread:
a) Craniotomy.
b) Ventriculosystemic shunts.
c) Prior radiotherapy or chemotherapy.
d) An increased time between diagnosis of tumor and death.
Very good.
Summarize the article:
Immunosuppressant medications is a risk factor of developing malignant tumor, as well as aggravating transmitted malignant tumor from donor to recipient, and i will fatal and complicate death and graft survival.
Delayed donation from patient with recent malignant tumor treated or on treatment is vital to ensure that the donor is free from any residual malignant tumor.
The Council of Europe in 1997, stated that while the donation from donor with low grade malignancy was safe, donation from donor with high grade malignancy have no considered safe and should be excluded from donation.
In ordered to make organ for donation available, the risk of disease transmission from malignant CNS tumor should be balanced carefully against risk of complication may develop as well as death in recipient waiting for transplantation.
Results:
data collected from 11,799 DOD in UK Transplant registry between 1985-2001. Among 5934 donors who registered to the cancer registries. Donors grouped as follow.
discussion:
Thankyou well done.
– Although patients dying from 1ry intracranial malignancy is a potential source of organs for donation , there is a risk for tumour transfer the the recipient , so this study collected Information from the UK Transplant Registry combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and analyses to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted.
– 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
– A total of 448 recipients of 495 organs from 177 of these donors were identified.
– No transmission of donor intracranial malignancy occurred.
– So , Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list but it is essential that the surgeon should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery.
– At the time of organ retrieval a thorough examination of the thoracic and abdominal cavities for metastatic tumor should be undertaken, as well as careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread; if found, and confirmed histologically, the organs should probably not be considered for transplantation.
– Finally, it is important that any patient being considered for transplantation where organs from donors with intracranial malignancy may be used, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list
Well done
III. How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data
————————————————————————————————————————————————————————————————————————————–
Introduction
Materials and Methods
————————————————————————————————————————————————————————————————————————————–
Results
Discussion
.
————————————————————————————————————————————————————————————————————————————–
Conclusion:
DONOR with primary intracranial malignancy ——— investigated for histology type , size, extension, and distant metastasis before consideration of organ donation.
At the time of organ retrieval, donors should be evaluated for metastasis.
Even when the risk of cancer transmission is low, recipients should be informed about the potential risk of cancer transmission .
Well done
Kidneys from cadaveric donors have been the predominant source of allografts in most countries due to the global shortage of kidney donors. Some researchers have proposed using organs from people who have primary intracranial cancer pending circulatory arrest.
Methods and Materials.
The potential for tumor spread from a donor with primary intracranial malignancy was assessed in this retrospective analysis. All organ donors with primary intracranial malignancy between 1985 and 2001 inclusive were identified, and the incidence of post-transplant malignancy in recipients of these organs was determined using data from the UK Transplant Registry and the national cancer registries of England, Wales, and Northern Ireland.179 donors identified with an intracranial malignancy donated organs to 526 recipients, and 448 recipients were tracked by cancer registries.
Results:
Only 5827 donors (49%) had a valid NHS number and were allowed direct link to the cancer registry data. An additional 107 donors were added after a manual investigation and after analysis of the data of those donors, only 179 donors were found to have intra-cranial cancer who transplanted 582 organs in 526 recipients with 325 kidneys, 76 hearts, 71 lungs, and 93 livers. Twenty-four recipients received two organs . This observational evaluation revealed no risk of intracranial tumor transmission to any of the registered 448 transplant recipients, despite the fact that 23 percent of recipients lacked complete data.
Conclusion:
Patients with primary intracranial malignancy should be investigated for histology type , size, extension, and distant metastasis before consideration of organ donation. At the time of organ retrieval, donors should be evaluated for metastasis.
Even when the risk of cancer transmission is low, recipients should be informed about the potential risk of cancer transmission .
You need to highlight the risk factors.
In immunosuppressed transplant recipients, transmission of donor-related malignancy via organ transplantation is a well-known and frequently deadly complication. As a result, even when there is no sign of metastasis, organs from potential donors who have active or recently treated malignant disease are typically not deemed appropriate for transplantation.
The use of organs from donors who have primary intracranial cancer, where the likelihood of spread outside the central nervous system, and consequently the risk to transplant recipients, is low, is a significant exception to this norm.
In 1997, the Council of Europe declared that although the use of organs from donors with low-grade primary malignancies was safe, organs from potential donors with high-grade malignant tumors of the central nervous system, particularly in cases where the blood-brain barrier’s integrity was weakened, should no longer be regarded as safe for transplantation.
Method
All UK transplant registry records for organ donors were located, and demographic data was sent to each of the 10 collaborating cancer registries. The data was then processed by the registries to identify organ donors who had a malignancy (current or past) noted in their medical history. These details were used to identify all recipients of organs from donors with a history of cancer from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006. This gave all transplant recipients a minimum follow-up period of five years.
The Council of Europe rules state that high-grade brain tumor donors’ organs should not be used due to the alleged increased risk of cancer transmission. Additionally, many donors who had primary intracranial cancer would have undergone procedures like debulking surgery, radiation, and the installation of ventriculosystemic shunts, all of which disrupt the blood-brain barrier and may be linked to systemic tumor cell dissemination.
The study was unable to identify the percentage of donors in the data set who received such interventions because the cancer registries did not keep complete records of the treatment of intracranial tumors.
Risk factors for brain tumor extraneural metastasis include craniotomies and significant resections, as well as stereotactic biopsy, which has been associated with tumor seeding down the needle route.
Ventriculosystemic shunts, prior radiotherapy or chemotherapy, and a longer interval between a tumor’s detection and death are a few other characteristics that have been linked to an increased chance of extraneural spread and donor cancer transmission.
The fact that roughly half of all intracranial tumors are secondary spread from extraneural primary tumors rather than primary brain tumors, which carry an unacceptable risk of disease transmission, should be noted.
well done
Summary of this article
Introduction
Donors who have active or recently treated malignant disease are not suitable for transplant except donors with primary intracranial malignancy as the risk of transmission is low. However case report of recipient had transmission of malignancy from donors with primary malignancy of CNS.
we need to weight the risk of the donor organ shortage for transplantation with the risk of primary CNS malignancy transmission.
The UK transplant registrar by NHS blood and transplant for organ transplant between 1985 and 2001.
Cancer registers in UK are population based collect data from histopathology ,laboratory ,radiotherapy ,chemotherapy and surgical unit and from multidisciplinary site specific cancer team meeting.
RESULT
Data from 11799 deceased organ donors notified to the UK transplant registry between 1985 to 2001 to the 10 participant UK cancer registries .
107 donors were identified by mainly investigating each donor using the NHS strategic tracing service.
From 5934 donors 227 donors having at least one cancer .
227 had an invasive malignancy.
179 had an intracranial cancer .
There were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients.
Discussion
Retrospective study of UK registry data showed that no any of the 448 recipients who received organ from 177 donors with primary intracranial malignancy .
23 donors with grate 4 glioma .
9 with modulo blastoma .
As there is high risk of cancer transmission from donor with high grate of brain tumour The council of Europe guidelines for bidden this type of organ transplant.
In transplant registries with some cases series they concluded that the risk of transmission of donor in cranial carcinoma is small.
But others transplant registry centre they summarized that donors with high grate ,the incidence of tumour transmission from organ donors is high 25%.
The surgeon should aware about donors with intracranial malignancy such as tumour histology and treatment include radiotherapy and surgery.
Communication with patients regarding his chance of transplant from the waiting list and as well there is risk of intracranial malignancy from donors.
Please revise the PI last paragraph due to over recording bias
SUMMARY
Introduction
There is an ever-increasing demand for organ due to long list those waiting for organs, despite this, organs from potential donors but with active or recently treated malignancy are being discarded because of concern of transmitting of the malignancy despite the extreme shortage. The council of Europe, advice the use of organs from donors’ low-grade intracranial malignancy while to preclude those with high grade despite different publication attesting to very small risk of transmission of the malignancy except in some circumstances like bridge of the CNS circulation.
Materials and Methods
Results
Conclusion
The concern that has been entertained on rate of transmission of malignancy from a potential donor to recipient of various organ seems not as serious as it was made to be by the council of Europe, and this has been attested to by various studies from Australia, New Zealand, and Czechoslovakia. Although, transplant surgeons were advised to watch out for features of cancers while transplanting an organ so as to alert others using other organs from the same donor. Moreso, recipient should be fully aware of the kind of potential donor they are receiving organ from of the possibility of transmission of cancer though remote.
Thankyou but you needed to point out the risk factors in these tumors that augmented transmission.
sorry for the omission
How Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy? An Analysis of UK Registry Data.
The target worldwide is to increase organ donor pool, this will occur with some challenges, one of these is transplantation from cadaveric. Here the question is about safety of transplantation from donor with primary intracranial malignancy.
Materials and Methods.
This is done in this retrospective study by evaluating the risk of tumor transmission by reviewing the incidence in patients transplanted in the UK. Data collected from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of post-transplant malignancy in the recipients of the organs transplanted.
179 donors identified with an intracranial malignancy donates organs for 526 recipients and 448 Recipients traceable by cancer registries.
Results:
Only 10 recipients were recorded as developing malignancy following transplantation, a new non-skin invasive malignancy, the most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD and no transmission of intracranial malignancy.
Conclusion:
When potential donors with intracranial malignancy are referred, we should be aware of all the relevant information, including tumor histology and treatment, including radiotherapy and surgery. At the time of organ retrieval, we should looking for any metastasis.
Transplantation from donors with intracranial malignancy may be used, we should counsel regarding the small but definite risk of transmission, as well as their chance of survival if they choose to remain on the waiting list.
Well done
Summary
Introduction
With the increase in the demand for organ supply to shorten the waiting list for organ transplantation may consider patients dying from primary intracranial tumors as a source of organs for transplantation. However, the use of such types of donors may be limited due to the risk of tumor transmission to the organ recipients however this should be wisely well-adjusted against the risk of potential recipient death while waiting of dialysis.
Aim of the study
To estimate the incidence of primary intracranial tumor transfer from organ donors based on a review of the data from both the UK transplant registry along with the national cancer registry in the UK
.
Methods
All donor’s and recipient’s demographics are collected and found on 81% of the cases by ID numbers from the national health service registry (NHS) as the UK transplant registry maintained by NHS from the period 1985-2001 and linked to the data registry from the national cancer registry and another 19% by using other demographic data (total of 8 regional cancer registries in the UK, North Ireland Wales and Scotland.
The cancer registry collects data from histopathology labs, radiotherapy, chemotherapy, surgical units, and MDT site-specific cancer team meeting, and review of the death certificates of the registrable neoplasm from the office of national statistics the data was available for 94% of all malignancies accept the nonmelanoma skin cancers, they identify 179 DD donors with intracranial tumor and 448 recipients with cancer with minimum FU of 5 years for all recipients.
Results
A total of 11,799 was notified by the UK registry from 1985-2001 only 5827 donors (49%) had a valid NHS number and were allowed direct link to the cancer registry data additional 107 donors were added after a manual investigation and after analysis of the data of those donors only 179 donors found to have intra cranial cancer who transplanted 582 organs in 526 recipients with 325 kidneys, 76 hearts, 71 lungs, and 93 livers, 24 recipients got two organs ( kidney and pancreas, liver and kidney, double lungs or double kidneys also the data for recipients available in 448, there is missing data in 23% of recipients, this observational review did not show any risk of intracranial tumor transmission to any of the registered 448 transplant recipients
Discussion
This is a retrospective UK registry observational study that reported that none of 177 DD with primary CNS tumors transmitted the malignancy to 448 recipients including high-grade tumors in 32 cases. and it was similar to the finding of other small studies from US and Australian registries and the agreements that the risk is trivial and only those with high-grade tumors with a history of intervention may consider for further discussion due to few reported cases of systemic transmission upon follow-up of the recipients. The risk of extra neural metastasis from intracranial tumors is rare even from high-grade tumors like GBM with vascular invasion. But those with a history of interventions like surgical debulking, craniotomy, shunt placement, chemotherapy, or radiation can break the BBB, and associated with the risk of tumor seeding around and down to the lymph nodes, However, the Council of Europe guidelines recommended that donors with high-grade brain tumors should be rejected due to the high risk of cancer transmission (5). We should take into consideration the above risk and the selection of the DD with primary intracranial tumor should be highly selective taking into consideration the low risk of tumor transmission we should not decline such donors unless they have high-grade tumors with recent intervention radiation and should balance with the risk of recipient mortality on the long waiting list on dialysis, we need larger studies in prospective design and longer Fu to address this limitation.
Limitation
Retrospective study with missing data of half of the registered cases (49%) of the donors (bias, underestimation)
Missing data about the treatments, and interventions that can affect the results (bias underestimation)
Missing data about the diagnostic criteria of a tumor carry the risk of under or overestimation the grade of the tumor
Missing data about the total number of deaths among donors with primary CNS tumors and among recipients on the waiting list.
Exellent Thankyou
Previous studies reported increased risk for malignant transmission from donors with primary intracranial tumors if there is one of the following risk factors including high grade tumors, previous craniotomy, intake of systemic chemotherapy and the presence of ventriculo-atria or ventriculo- peritoneal shunts that disrupt the blood brain barrier
This is a retrospective study evaluating 179 deceased donor with primary intracranial malignancy of which 33 were high grade (24 grade IV gliomas and 9 medulloblastomas) diagnosed by imaging and/or histology regarding transmission of donor malignancy to the recipients
Results
Conclusion
Thankyou
Material and Methods:
NHS Blood and Transplant maintain the UK Transplant Registry. This retrospective cohort study evaluated donor and recipient demographics and organ transplant records from 1985 to 2001. Name, NHS number, date of birth, gender, and postcode were needed to connect to cancer registry databases. In 81% of instances, the connection was based on NHS numbers and 19% on demographic information. Population-based cancer registries in the UK gather data from histology labs, radiation, chemotherapy, and surgical facilities, and multidisciplinary site-specific cancer team meetings.
Results:
Of the 5934 donors with the necessary, 227 had at least one cancer, Of the 227 donors with invasive disease, 179 had intracranial cancer.325 kidneys, 76 hearts, 71 lungs, 93 livers, 8 liver lobes, and 9 pancreases were transplanted. 24 people received 2 organs (pancreas and kidney, liver and kidney, double lung or double kidney), and 16 got 3. (all heart and lung transplants).448 of 526 patients with primary intracranial cancer got 495 organs. The significant finding was that none of the 448 transplant patients whose data could be evaluated had intracranial cancer. 10 transplant recipients developed cancer. As predicted, 4 of 448 (1%) patients developed PTLD.
Discussion:
When prospective donors with intracranial malignancy are referred, the surgeon must know tumour histology and treatment, including radiation and surgery. At the time of organ retrieval, the thoracic and abdominal cavities should be examined for metastatic tumour, as well as any craniotomy site and adjacent lymph nodes for extraneural dissemination; if identified, and proven histologically, the organs should not be considered for transplantation. Any patient considering transplantation where organs from intracranial cancer donors may be utilized should be educated about the modest but clear risk of transmission, as well as their probability of survival if they opt to wait.
Conclusion:
Primary intracranial cancer patients may donate organs.
A fear of tumour transmission has restricted their usage. We analyzed tumour transmission risk in UK transplant patients. 179 of 11 799 organ donors had primary intracranial cancer, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). From 177 donors, 448 people received 495 organs. No intracranial cancer was transmitted.
Thankyou Exellent
Please provide a summary of this article
The huge need for organs to the patients on the waiting list, makes it worthy to look after those cadaver donors and their cause of death, this study consider those with known malignancy by the UK transplant registry(NHS), form those 177 donors known to have brain tumor, 495 organs were transplanted in to 448 donors, 10 Recipients developed a new non-skin invasive malignancy.
out of them 23 donors had grade IV glioblastoma, and 9 with medulloblastoma- provided organs to 85 donors, many would have undergone interventions such as debulking surgery, radiotherapy and ventriculosystemic shunt placement, all of which breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells.
in a series included 175 recipients where the donor tumor was a GBM and the only recorded transmission occurred to three recipients, Metastatic GBM was noted in a lymph node at the time of bilateral lung transplantation; it was also transferred to the recipients of the liver and one kidney.
Detailed information of the patient history is must, pathological diagnosis, h/o intracranial shunts and previous craniotomy, radiotherapy. and at the time of organ retrieval, a thorough examination of the thoracic and abdominal cavities for metastatic tumor, careful assessment of any craniotomy site and related lymph nodes for evidence of extraneural spread should be done, if present and histologically evident organ decline is proper.
Any patient being considered for transplantation from donors with intracranial malignancy, should be counseled regarding the small but definite risk of transmission, as well as their chance of survival if they
choose to remain on the waiting list.
Thankyou
The UK Transplant Registry is maintained by (NHS)
demographic information on both donor and recipient for organ transplants undertaken between 1985 and 2001
cancer registry data bases
There are eight regional cancer registries in England
The Cancer Registries coded intracranial malignancy on the basis of available histology and/or other relevant information such as cross-sectional imaging according to the 10th (WHO ICD-10).
Results:
Demographic data from 11,799 deceased organ donors
between 1985- 2001
5934 donors with the appropriate information to allow linkage to the cancer registries,
227 donors were identified as having at least one cancer, excluding those with
Of the 227 donors who had an invasive malignancy, 179 had an intracranial cancer
from whom 582 organs were transplanted into
526 recipients, including
Twenty-four recipients received 2 organs
and 16 received 3 organs
Of the 526 recipients, data were available for 448 recipients who received 495 organs from 177 donors with primary intracranial malignancy
The key observation was that there were no recorded cases of transmission of intracranial malignancy to any of the 448 transplant recipients whose data could be analyzed.
Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers.
4 of the 448 (1%) recipients, was PTLD
Discussion
There were many donors with high-grade tumors, including 23 grade IV gliomas (glioblastoma multiforme, GBM) and 9 with medulloblastoma who provided organs for 85 traceable recipients.
According to the Council of Europe guidelines, organs from donors with high-grade brain tumors should not be used because of the perceived high risk of cancer transmission.
many donors with primary intracranial malignancy would have undergone interventions such as debulking surgery, radiotherapy and ventriculo systemic shunt placement-, and potentially associated with systemic dissemination of tumor cells.
In this study, they were unable to determine the proportion of donors in the data set who underwent such interventions.
small proportion of donors the diagnosis was made solely according to the appearance on cross-sectional imaging in the absence of corroborative histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
When histology was available the reports were not coded by the reporting pathologist and we have no data on whether the histological diagnosis was made before death or at autopsy.
What is clear is that guidelines such as those issued by the Council of Europe should not be taken in isolation, but the risk of disease transmission should be balanced against the risk of recipient death without a transplant, a risk that is ever more acute as the gap between the number of available organs and the number of potential recipients widens, in spite of recent initiatives to increase deceased donation rates
In the face of increasing waiting list mortality, it could be argued that the absence of transmission of donor intracranial malignancy in the present UK series reflects an inappropriate degree of clinical conservatism.
selectively declined donors with
In addition, there is an inevitable fear of commission, that is, of actively transplanting an organ that might result in a patient dying as a result of transmitted malignancy.
In contrast, when the surgeon is guilty of omission, that is, of declining the organs from donors with primary intracranial malignancy, they feel less responsible for a subsequent waiting list death and are less culpable in the eyes of the patient’s family.
When potential donors with intracranial malignancy are referred, it is essential the surgeon should be aware of all the relevant information, including
Very good but long and despite that no mention of other registries
Summary:
· cadaveric donors with intracranial malignancy were precluded, however the Shortage of donor pool made it essential to investigate the risk of transmission to the recipient.
· The current study found that No risk of transmission was observed among 448 recipients of 495 organs from 177 of these donors were identified, even with high grades, so can be used safely.
· The small risk of transmission (especially after commencing immunosuppressive therapy) should be balanced against the risk of mortality when being on dialysis.
· Debulking surgery, radiotherapy and ventriculosystemic shunt placement, all breach the blood brain barrier and are potentially associated with systemic dissemination of tumor cells which can carry a risk of cancer transmission to the recipient
· So, the transplant team:
o Should counsel the recipient about the small, but definite risk of transmission with obtained written consent.
o Should examine the thoracic and abdominal organs for any evidence of dissemination.
o Should examine the craniotomy site, and be aware of the site , grade and histological type of malignancy.
· Both living and cadaveric donors with active malignancy are contraindications for donation due to risk of transmission. However, intracranial malignancy with intact blood brain barrier, low grade tumor and no dissemination is an exception.
Thankyou well done
The use of organs from donors with primary intracranial malignancy, where the risk of spread outside the CNS, and hence the risk to transplant recipients, is low. Organs from such donors have been used for transplantation over many years, on the basis that disease transmission was rare.
A reliable estimate of the true risk of transmission of an intracranial malignancy is necessary to enable a balanced decision to be made regarding the risks to potential recipients.
Method:
Study aim: to quantify the risk of transmission of a primary intracranial malignancy from an organ donor.
Data source: from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors.
UK cancer registries have estimated completeness of registration to be 94% for all malignancies excluding nonmelanoma skin cancer
Study period: between 1985 and 2001
Inclusion: donors with a primary intracranial malignancy.
all recipients of organs from donors with a history of malignancy were identified from the UK Transplant Registry data base, and their demographics were then transferred back to the cancer registries to identify the occurrence of recipient cancers up to and including 2006, giving a minimum follow-up period of 5 years for all transplant recipients.
Results:
Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas).
A total of 448 recipients of 495 organs from 177 of these donors were identified.
No transmission of donor intracranial malignancy occurred.
Only 10 recipients were recorded as developing malignancy following transplantation, excluding those who developed primary skin cancers.
The most common type of malignancy, which occurred in 4 of the 448 (1%) recipients, was PTLD
Conclusion:
Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.
Limitations:
The cancer registries did not record complete data on the treatment of intracranial tumors.
Data were not available on the mode of diagnosis of the tumor (biopsy, craniotomy or autopsy) or only based on the appearance on imaging in the absence of histology, which carries a risk of both under and overestimating the grade of intracranial malignancy.
Thankyou for the comprehensive and analytical summary.
Good conclusions but the least conclusive statistics are needed