Tom 3, Nr 4 (2023)
Poglądy, stanowiska, zalecenia, standardy
Opublikowany online: 2023-10-20
Wyświetlenia strony 239
Wyświetlenia/pobrania artykułu 43
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Zasady zapobiegania przeniesieniu nowotworu złośliwego od dawcy do biorcy przeszczepu. Oznaczanie markerów nowotworowych przy kwalifikacji dawców narządów. Stanowisko Grupy Roboczej Polskiego Towarzystwa Transplantacyjnego Wydanie trzecie uaktualnione

Alicja Dębska-Ślizień1, Jarosław Czerwiński23, Leszek Domański4, Maciej Kosieradzki5, Krystyna Serkies6
DOI: 10.5603/fn.97781
Forum Nefrologiczne - Edukacja 2023;3(4):155-191.

Streszczenie

Przeniesienie nowotworu złośliwego od dawcy do biorcy przeszczepu zdarza się bardzo rzadko (6/10 000 transplantacji — ONT Registry Spain; 1,7/10 000 transplantacji — UNOS Registry USA); 6/10 000 — United Kingdom Transplant Registry), niesie za sobą jednak poważne konsekwencje. Z tego względu celem pomniejszenia ryzyka transmisji komórek nowotworu z przeszczepionym narządem obowiązkowa jest ocena dawcy pod kątem obecności choroby nowotworowej w czasie oceny potencjalnego dawcy lub w przeszłości. Przestrzeganie ogólnych zaleceń pozwala w dużej mierze uniknąć przeniesienia nowotworów, niemniej każdy potencjalny dawca, szczególnie dawca w podeszłym wieku, wymaga wnikliwej oceny pod tym kątem. Ryzyko przeniesienia zależy od rodzaju nowotworu (typ histopatologiczny i stopień zróżnicowania histopatologicznego; grading) oraz stopnia klinicznego zaawansowania nowotworu (staging). W przypadku niektórych nowotworów, jak rak podstawnokomórkowy (BCC) i płaskonabłonkowy skóry (SCC), ryzyko przerzutów narządowych jest znikome, stąd narządy od takich dawców mogą być akceptowane do przeszczepienia. W przypadku innych nowotworów, w tym nowotworów mózgu podejście zależy nie tylko od rodzaju nowotworu i jego zaawansowania, ale również od polityki ośrodka transplantacyjnego oraz sytuacji klinicznej biorcy.

W Europie nie ma jednolitych zaleceń odnośnie akceptacji dawców z nowotworem rozpoznanym przed i w trakcie pobierania narządów.

W niniejszym opracowaniu przedstawiono rekomendacje European Directorate for the Quality of Medicines & Health Care (EDQM), Council of Europe, Guide to the quality and safety of Organs for Transplantation 8th Edition z 2022 roku oraz stanowisko Grupy Roboczej Polskiego Towarzystwa Transplantacyjnego (GR PTT) odnośnie tego zagadnienia. Grupa Robocza, ze względu na brak przyjętego w Europie standardu postępowania, niewielką liczbę doniesień o ryzyku przeniesienia nowotworu i niską wartość naukową publikacji epidemiologicznych na temat przeniesienia nowotworu z przeszczepianym narządem, formułuje jedynie stanowisko ekspertów, a nie zalecenia postępowania.

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