Elsevier

Transplantation Proceedings

Volume 50, Issue 7, September 2018, Pages 1982-1984
Transplantation Proceedings

13th Congress of the Polish Transplantation Society: Part II
Organ donation
Prostate Cancer in Deceased Organ Donors: Loss of Organ or Transplantation With Active Surveillance

https://doi.org/10.1016/j.transproceed.2018.02.129Get rights and content

Highlights

  • Eligibility of donors diagnosed as having prostate cancer is proposed to expand the donor organ pool.

  • No disease progression and cancer-related death was observed among liver transplant recipients.

  • Use of organs from donors diagnosed as having prostate cancer should not be avoided, but recipients must be put on active surveillance.

Abstract

Introduction

Prostate cancer has become an important clinical issue within deceased organ donors. There is still a considerable number of undiagnosed cancers, especially in early stage, despite frozen section analysis. The aim of the study was to evaluate outcomes of orthotopic liver transplants (OLTx) with organs from donors with prostate cancer.

Material and Methods

A retrospective analysis was performed in deceased liver donors whose prostate glands were harvested for histologic examinations because of prostate cancer suspicion. The study group consisted of 72 men reported as potential liver donors between 2011 and November 2017. Prostate glands were primarily assessed by frozen sections and afterward in routine examination. Generally cancer diagnosed in frozen specimen was not considered for OLTx. Recipients who received an organ from the donor with prostate cancer were actively surveilled.

Results

There were 19 cases (26.40%) of prostate cancer diagnosed among the study group. In 12 cases diagnosis was made by frozen section assessment, of which 11 organs were disqualified from OLTx and 1 was transplanted. In 7 cases prostate cancer was diagnosed after OLTx in final routine histologic examination. Finally, 8 recipients (5 men and 3 women) received a new organ. Only 1 died during the perioperative period. In the remaining 7 patients the perioperative period was uneventful and no disease transmission was observed during follow-up.

Conclusions

Diagnosis of prostate cancer in donors should not be treated as a contraindication for OLTx because the risk of disease transmission is low. Potential recipients must be fully informed and kept under oncological surveillance.

Section snippets

Material and Methods

We retrospectively analyzed 72 cases in which transplanted organs were derived from donors whose prostate glands were histologically examined because of elevated PSA level (>10 ng/dL) and abnormal digital rectal examination. Intraoperatively diagnosed pelvic lymph node enlargement was another indication for histologic examination of prostate glands. Examination was first performed on frozen sections. Final diagnoses were made after 7 days by routine histologic examinations. All OLTx were

Results

Among all examined prostate glands (n = 72) there were 19 cases (26.40%) of cancer. Twelve were previously diagnosed during examination of frozen specimens and confirmed during final examination. Eleven livers derived from these donors were disqualified from OLTx and 1 was transplanted after risk acceptance and receipt of formal consent from the recipient. In the remaining 7 cases harvested livers were transplanted because of positive results of frozen section analyses, and prostate cancers

Discussion

Prostate cancer among donors raises serious clinical and decision-making issues. On the one hand, we are facing organ shortage; on the other hand, expanding the donor pool to patients with malignant disease raises concerns about disease transmission. Up to now, it was necessary to exclude the presence of prostate and any other carcinoma in donors before transplant of harvested organs. However, normal concentration of PSA in donors cannot justify the exclusion of prostate cancer; the

Conclusions

  • 1.

    Number of prostate cancer cases will systematically grow due to extending donor organ age.

  • 2.

    Diagnosis of prostate cancer in potential organ donors cannot disqualify them from transplantation.

  • 3.

    Deceased donor pool can be extended to patients with early-stage prostate cancer.

References (14)

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Cited by (4)

  • Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment

    2021, Transplantation Reviews
    Citation Excerpt :

    A complete summary of cancers discovered with whole autopsy with available data is found in Table 1. There were four studies [18–21] limited to autopsy assessment of the prostate gland with a median number of donors of 148 (range 11–340), a median number of donors with prostate cancer of 12.5 (range 1–41) and a median number of cancers which were specifically discovered at the post-transplant/limited autopsy of 6.5 (range 1–41). In these studies, the prostate was studied after the removal of organs or tissues and there were no transmission events in the recipients.

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