Transmission of donor cancer into cardiothoracic transplant recipients

Background. The demand for transplantable organs exceeds donor supply. Pati ents with central nervous system (CNS) or other tumors are controversial do nors, and the donor cancer transmission rates in cardiothoracic transplant recipients have not been determined. The Israel Penn International Transpla nt Tumor Registry (IPITTR) was queried to define the risk of donor cancer t ransmission in cardiothoracicc transplant recipients. Methods. All heart, lung, or heart-lung recipients of organs from donors wi th a history of malignancy were reviewed. Donor and recipient demographics, histologic findings, and recurrence were reviewed. Results. Twenty-two patients received 17 hearts, 3 lungs, and 2 heart-lung transplants from donors with known CATS or other malignancies. No malignanc y transmissions were noted with astrocytomas (n = 3) or glioblastomas (n = 1), except a medulloblastoma m a that recurred at 6 months. The, transmissi on rate for CNS tumors was 17% (1 of 6), and 1- and 3-year survivals were 6 7% and 50% respectively. Tilt, most common non-CM donor cancer was renal ce ll carcinoma (n = 5). Two renal cell cancer transmissions occurred, both wh en vascular extension was present. The most aggressive tumor transmission w as choriocarcinoma (n = 2) and melanoma (n = 2). Two of 3 choriocarcinomas metastasized with 67% mortality, and both melanomas were transmitted and re sulted in death. Other donor cancers included angiosarcoma (n = 2), cervica l (n = 1), lung (n = 1), prostate (n = 1), and a liver adenocarcinoma. The transmission rate for all non-CNS groups was 56% (9 of 16) with a 2-year su rvival of 40%. Conclusions. The IPITTR experience indicates that tumor transmission is hig h (10 of 22, 45%) in cardiothoracic transplant recipients. Similar to intra -abdominal organ recipients in the IPITTR, (1) renal cell carcinomas withou t capsular invasion appear safe with no transmission, (2) vascular invasion in renal cell carcinoma appears to result in early tumor transmission, and (3) melanoma and choriocarcinoma have high rates of transmission with earl y and almost universal death.