Is It Safe to Transplant Organs from Deceased Donors with CNS Tumor?

Abstract

Background A brain dead donor caused by central nervous system (CNS) tumor is generally included in the donor category for organ transplantation, but it is done in a selective way to prevent possible risk of cancer transmission through donation. In order to evaluate the possibility of tumor transmission from donor with CNS tumor, we reviewed and analyzed 91 recipients from 28 donors with CNS tumor retrospectively. Methods From January 1, 2005 to December 31, 2014, 28 donors with CNS tumor and 91 recipients who received solid organs from these donors were included. Based on KONOS donor data registry, we conducted donors and recipients survey at the hospitals where transplantation had been done. Results Twentyone donors were categorized into four histologic grades by WHO except 7 donors who has no detailed report of CNS tumor classification. Among them, 11 donors were grouped in grade I tumor (52.4%), and 3 were in group II(14.3%), 4 in grade III(19.0%) and 3 in grade IV(14.3%). According to high risk categories defined by the malignancy subcommittee of DTAC committee, intracranial surgery were done in 11 donors, chemo-radiotherapy in 2 patients, and 3 patients had chemo-radiotherapy after surgery. Therefore, 76.2% of those donors were in the highrisk category. A total of 91 transplants (25 livers, 52 kidneys, 7 hearts, 3 lungs, and 4 multi-organ transplants) were performed from donors with CNS tumors, and 85 recipients were finally analyzed after excluding 6 recipients whose current status were not confirmed. Of the 85 recipients, 14 were dead, of which 11 recipients were not associated with brain tumor as a death cause, and remaining 3 recipients, causes of death were unable to identify. However, there were 7 recipients who developed tumor after transplantation. One of them them recurred original recipient tumor (HCC) and remained 6 patients were diagnosed as non-CNS tumor (renal cell carcinoma, carcinoma in situ of cervix, B cell lymphoma, thyroid ca., kaposi’s sarcoma and colon ca). Conclusion Even though the possibility of tumor transmission from donor with CNS tumor is rare, we still have to focus de novo malignancy incidence after transplantation. So we need more precise post-transplant evaluation to detect de novo malignancy in recipients who has organs from CNS tumor.