If the donor had an early-stage genitourinary carcinoma and the liver has already been implanted, should we perform the transplantectomy?

Abstract

Information regarding the outcome of liver grafts from cadaveric donors with genitourinary cancer is scarce. In some cases, the liver has already been implanted when the tumor is detected. What must we do then? Our goal is to evaluate the outcome of recipients of liver allografts from donors with unsuspected early-stage genitourinary carcinoma. We performed 684 liver procurements from cadaveric donors and 582 liver transplants. A malignant genitourinary tumor was detected in the donor after implantation of the donor liver in six cases (1.03%): four renal carcinomas and two prostate cancers. All donors were elderly (mean age, 64.6 years) and died of a cerebrovascular accident. Four patients are still alive and presently free of malignancy, whereas the two other transplant recipients died of hepatitis C virus recurrence at 14 and 55 months after transplantation without evidence of tumor transmission. We did not observe evidence of tumor transmission in any patient after an average follow-up of 51 +/- 20 months. Our results suggest it is not always necessary to perform transplantectomy or use special treatment modalities in recipients of a liver allograft from donors with early-stage (T1 to T2) renal cell carcinoma or early (T1) prostate carcinoma.