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. 2022 Feb 4:35:10092.
doi: 10.3389/ti.2021.10092. eCollection 2021.

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

George H B Greenhall  1   2 , Maria Ibrahim  1   2 , Utkarsh Dutta  3 , Carolyn Doree  4 , Susan J Brunskill  4 , Rachel J Johnson  1 , Laurie A Tomlinson  5 , Chris J Callaghan  2   6 , Christopher J E Watson  7   8   9
Affiliations

Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

George H B Greenhall et al. Transpl Int. .

Abstract

Donor-transmitted cancer (DTC) has major implications for the affected patient as well as other recipients of organs from the same donor. Unlike heterotopic transplant recipients, there may be limited treatment options for orthotopic transplant recipients with DTC. We systematically reviewed the evidence on DTC in orthotopic solid organ transplant recipients (SOTRs). We searched MEDLINE, EMBASE, PubMed, Scopus, and Web of Science in January 2020. We included cases where the outcome was reported and excluded donor-derived cancers. We assessed study quality using published checklists. Our domains of interest were presentation, time to diagnosis, cancer extent, management, and survival. There were 73 DTC cases in liver (n = 51), heart (n = 10), lung (n = 10) and multi-organ (n = 2) recipients from 58 publications. Study quality was variable. Median time to diagnosis was 8 months; 42% were widespread at diagnosis. Of 13 cases that underwent re-transplantation, three tumours recurred. Mortality was 75%; median survival 7 months. Survival was worst in transmitted melanoma and central nervous system tumours. The prognosis of DTC in orthotopic SOTRs is poor. Although re-transplantation offers the best chance of cure, some tumours still recur. Publication bias and clinical heterogeneity limit the available evidence. From our findings, we suggest refinements to clinical practice. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020165001, Prospero Registration Number: CRD42020165001.

Keywords: cancer; deceased organ donors; donor-transmitted disease; heart transplantation; liver transplantation; lung transplantation.

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Conflict of interest statement

CW has no direct conflict of interest related to this work. In the last 3 years his department has received consultancy fees on his behalf from Nefro Health and GlaxoSmithKline, and speaker fees from OrganOx. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study screening flowchart. aIncludes 2,298 from search strategy and 8 from hand searches (5 from WHO NOTIFY Library, 3 from reference lists). bIncludes donor-derived cancer.
FIGURE 2
FIGURE 2
Kaplan-Meier plot of patient survival after donor-transmitted cancer diagnosis, by transplant type. Restricted to cases with follow-up of at least 6 months, or to death (n = 49). Follow-up censored at 3 years. Liver includes liver-pancreas-intestine (1), lung includes heart-lung (1). DTC, donor-transmitted cancer.
FIGURE 3
FIGURE 3
Kaplan-Meier plot of patient survival after donor-transmitted cancer diagnosis, by re-transplantation. Restricted to cases with follow-up of at least 6 months, or to death, and no tumour beyond allograft at diagnosis (n = 26). Follow-up censored at 3 years. Re-transplanted cases: liver recipients (n = 13); cases not re-transplanted: liver (n = 10), lung (n = 3) recipients. DTC, donor-transmitted cancer.
See this image and copyright information in PMC

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