RENAL CELL CANCER DONOR TUMOR TRANSMISSION

Abstract

P135 One of the most common malignancies identified in organ donors either at the time of organ donation or inadvertently after transplantation is Renal Cell Carcinoma (RCC). To examine the outcome of utilizing organs and the potential therapeutic options available in recipients of such organs we examined all reported cases of potential donor transmission. Methods: Donors with a history of RCC prior to donation were identified from our database. Data was analyzed to identify risk factors. Results: 72 recipients of organs from donors with a known or incidental renal cell carcinoma were examined. Forty Seven (65%) tumor transmissions were identified, which were categorized into three groups: 1) incidental tumors excised prior to implantation (n=14) all were renal allografts, no tumor recurrences were noted with a 93% patient and graft survival, 2) incidental RCC identified in the allograft with 6 months of transplantation, all underwent partial nephrectomy with no tumor recurrence and 100% patient and graft survival, 3) the remaining group presented with extensive allograft involvement and/or diffuse metastatic disease. In patients with isolated allograft disease (n=17) all renal recipients (1LRD, 16 CAD) the mean time to diagnosis was 2.9 mos. All these patients underwent incidental or therapeutic explantation with an 89% survival; 2 patients died from non-malignant causes. Of those patients with allograft and metastatic disease, all were cad recipients, 8 were kidney and 1 heart; mean time to diagnosis was 9.5 mos. Two patients (22%) survived; both were managed by explantation immunosuppression discontinuation and immunotherapy. The average time to dearth was 11.4 mos. In the mets alone all were cad recipients; 3 were kidney and one lung recipient. Mean time to diagnosis was 21.6 mos with a 25% survival. The sole survivor was treated with explantation, immunosuppression and immunotherapy. The mean time to death was 21.6 mos. In the non trans group (n=25) 4 were heart and 6 liver and 15 kidney recipes, 5 explants performed for unrelated reasons, and 7 death non-malignant reasons. Conclusions: RCC donor transmission present in various forms of smaller cancers can be excised and renal allograft function preserved. In cases of extensive allograft involvement explantation and immunosuppression discontinuation is essential to salvage the patient. In these cases of met dz survival is dismal (23%) and survival is based on explant immuno dc and immunotherapy.