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
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.
Referencje
- Armanios MY, Grossman SA, Yang SC, et al. Transmission of glioblastoma multiforme following bilateral lung transplantation from an affected donor: case study and review of the literature. Neuro Oncol. 2004; 6(3): 259–263.
- Kauffman H, McBride M, Cherikh W, et al. Transplant tumor registry: donors with central nervous system tumors1. Transplantation. 2002; 73(4): 579–582.
- Hynes CF, Ramakrishnan K, Alfares FA, et al. Risk of tumor transmission after thoracic allograft transplantation from adult donors with central nervous system neoplasm-A UNOS database study. Clin Transplant. 2017; 31(4).
- Kauffman HM, McBride M, Cherikh W, et al. Transplant tumor registry: donor related malignancies. Transplantation. 2002; 74(3): 358–362.
- Birkeland SA, Storm HH. Risk for tumor and other disease transmission by transplantation: a population-based study of unrecognized malignancies and other diseases in organ donors. Transplantation. 2002; 74(10): 1409–1413.
- Moench K, Breidenbach T, Fischer-Fröhlich CL, et al. 6-Year Survey of Organ Donors with Malignancies in Germany. Transplantation Journal. 2012; 94(10S): 527.
- Desai R, Collett D, Watson CJ, et al. Cancer transmission from organ donors-unavoidable but low risk. Transplantation. 2012; 94(12): 1200–1207.
- Desai R, Collett D, Watson CJE, et al. Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry. Br J Surg. 2014; 101(7): 768–774.
- Mahíllo B, Martín S, Molano E, et al. Malignancies in Deceased Organ Donors: The Spanish Experience. Transplantation. 2022; 106(9): 1814–1823.
- Eccher A, Lombardini L, Girolami I, et al. How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J Nephrol. 2019; 32(2): 323–330.
- Guide to the Quality and Safety of Organs for Transplantation, 8th Edition. European Directorate for the Quality of Medicines & Health Care (EDQM), Council of Europe 2022.
- Stanowisko Poltransplantu w sprawie oznaczania markerów nowotworowych. http://www.poltransplant.org.pl/informacje.html.
- American Joint Committee on Cancer. AJCC Cancer Staging Manual, 8th edn 2016 [5/10/2019]. https: //cancerstaging.org/Pages/default.aspx (11 June 2021).
- Louis DN, Perry A, Wesseling P, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; 131(6): 803–820.
- European Parliament and Council. Directive 2010/53/EU on standards of quality and safety of human organs intended for transplantation. Brussels: EU Publications Office, 7 July 2010.
- Landry CS, Woodall C, Scoggins CR, et al. Analysis of 900 appendiceal carcinoid tumors for a proposed predictive staging system. Arch Surg. 2008; 143(7): 664–70; discussion 670.
- Penn I. Primary kidney tumors before and after renal transplantation. Transplantation. 1995; 59(4): 480–485.
- Xiao D, Craig JC, Chapman JR, et al. Donor cancer transmission in kidney transplantation: a systematic review. Am J Transplant. 2013; 13(10): 2645–2652.
- Nalesnik MA, Woodle ES, Dimaio JM, et al. Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transplant. 2011; 11(6): 1140–1147.
- Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003; 97(7): 1663–1671.
- Pavlakis M, Michaels MG, Tlusty S, et al. Renal cell carcinoma suspected at time of organ donation 2008-2016: A report of the OPTN ad hoc Disease Transmission Advisory Committee Registry. Clin Transplant. 2019; 33(7): e13597.
- Meyding-Lamade U, Krieger D, Schnabel P, et al. Cer¬ebral metastases of an allogenic renal cell carcinoma in a heart recipient without renal cell carcinoma. J Neurol. 1996; 243(5): 425–7.
- Sack FU, Lange R, Mehmanesh H, et al. Transferral of extrathoracic donor neoplasm by the cardiac allograft. J Heart Lung Transplant. 1997; 16(3): 298–301.
- Barrou B, Bitker MO, Delcourt A, et al. Fate of a renal tubulopapillary adenoma transmitted by an organ donor. Transplantation. 2001; 72(3): 540–541.
- Yu N, Fu S, Fu Z, et al. Allotransplanting donor kidneys after resection of a small renal cancer or contralateral healthy kidneys from cadaveric donors with unilateral renal cancer: a systematic review. Clin Transplant. 2014; 28(1): 8–15.
- Buell JF, Trofe J, Hanaway MJ, et al. Transmission of donor cancer into cardiothoracic transplant recipients. Surgery. 2001; 130(4): 660–6; discussion 666.
- Delahunt B, Sika-Paotonu D, Bethwaite PB, et al. Grading of clear cell renal cell carcinoma should be based on nucleolar prominence. Am J Surg Pathol. 2011; 35(8): 1134–1139.
- Warren AY, Harrison D. WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies. World J Urol. 2018; 36(12): 1913–1926.
- Llamas F, Gallego E, Salinas A, et al. Sarcomatoid renal cell carcinoma in a renal transplant recipient. Transplant Proc. 2009; 41(10): 4422–4424.
- Shariat SF, Palapattu GS, et al. Amie GEl Character¬istics and outcomes of patients with carcinoma in situ only at radical cystectomy. Urology. 2006; 68(3): 538–542.
- Sánchez-Chapado M, Olmedilla G, Cabeza M, et al. Prevalence of prostate cancer and prostatic intraepithelial neoplasia in Caucasian Mediterranean males: an autopsy study. Prostate. 2003; 54(3): 238–247.
- Yin M, Bastacky S, Chandran U, et al. Prevalence of incidental prostate cancer in the general population: a study of healthy organ donors. J Urol. 2008; 179(3): 892–5; discussion 895.
- Eccher A, Cima L, Ciangherotti A, et al. Rapid screening for malignancy in organ donors: 15-year experience with the Verona "Alert" protocol and review of the literature. Clin Transplant. 2017; 31(9).
- Egevad L, Delahunt B, Yaxley J, et al. International Society of Urological Pathology (ISUP) Grading of Prostate Cancer. Am J Surg Pathol. 2016; 40(6): 858–861.
- Doerfler A, Tillou X, Le Gal S, et al. Prostate cancer in deceased organ donors: a review. Transplant Rev (Orlando). 2014; 28(1): 1–5.
- Dholakia S, Johns R, Muirhead L, et al. Renal donors with prostate cancer, no longer a reason to decline. Transplant Rev (Orlando). 2016; 30(1): 48–50.
- Loh E. Development of Donor-Derived Prostate Cancer in a Recipient Following Orthotopic Heart Transplantation. JAMA: The Journal of the American Medical Association. 1997; 277(2): 133.
- Sánchez-Montes C, Aguilera V, Prieto M, et al. Periesophageal Lymph Node Metastasis of Prostate Adenocarcinoma From Liver Transplant Donor. Am J Gastroenterol. 2019; 114(3): 378.
- Friedman A, Muthiah C, Beebe T, et al. Collective experience with renal transplantation from donors with a history of breast cancer. Am J Transplant. 2003; 3(S5): 288–289.
- Miller AK, Young JW, Wilson DJ, et al. Transmission of Donor-Derived Breast Carcinoma as a Recurrent Mass in a Keratolimbal Allograft. Cornea. 2017; 36(6): 736–739.
- Sonbol MB, Halling KC, Douglas DD, et al. A Case of Donor-Transmitted Non-Small Cell Lung Cancer After Liver Transplantation: An Unwelcome Guest. Oncologist. 2019; 24(6): e391–e393.
- Lipshutz GS, Baxter-Lowe LA, Nguyen T, et al. Death from donor-transmitted malignancy despite emergency liver retransplantation. Liver Transpl. 2003; 9(10): 1102–1107.
- Snape K, Izatt L, Ross P, et al. Donor-transmitted malignancy confirmed by quantitative fluorescence polymerase chain reaction genotype analysis: a rare indication for liver retransplantation. Liver Transpl. 2008; 14(2): 155–158.
- Zelinkova Z, Geurts-Giele I, Verheij J, et al. Donor-transmitted metastasis of colorectal carcinoma in a transplanted liver. Transplant International. 2011; 25(1): e10–e15.
- Yamaçake KGR, Antonopoulos IM, Piovesan AC, et al. Donor transmission intestinal carcinoma after kidney transplantation: case report. Transplant Proc. 2015; 47(3): 827–830.
- Buell JF, Beebe TM, Trofe J, et al. Donor transmitted malignancies. Ann Transplant. 2004; 9(1): 53–56.
- Ison MG, Nalesnik MA. An update on donor-derived disease transmission in organ transplantation. Am J Transplant. 2011; 11(6): 1123–1130.
- Gerstenkorn C, Thomusch O. Transmission of a pancreatic adenocarcinoma to a renal transplant recipient. Clin Transplant. 2003; 17(5): 473–476.
- Georgieva LA, Gielis EM, Hellemans R, et al. Single-Center Case Series of Donor-Related Malignancies: Rare Cases With Tremendous Impact. Transplant Proc. 2016; 48(8): 2669–2677.
- Green M, Covington S, Taranto S, et al. Donor-derived transmission events in 2013: a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee. Transplantation. 2015; 99(2): 282–287.
- Eccher A, Lombardini L, Girolami I, et al. How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J Nephrol. 2019; 32(2): 323–330.
- Lipshutz GS, Mihara N, Wong R, et al. Death from metastatic donor-derived ovarian cancer in a male kidney transplant recipient. Am J Transplant. 2009; 9(2): 428–432.
- Nickkholgh A, Frey E, Krenzel C, et al. The need for vigilance in extended criteria donors with a past history of malignancy: a case report and review of literature. Ann Transplant. 2011; 16(1): 75–79.
- Green M, Covington S, Taranto S, et al. Donor-derived transmission events in 2013: a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee. Transplantation. 2015; 99(2): 282–287.
- Xiao D, Craig JC, Chapman JR, et al. Donor cancer transmission in kidney transplantation: a systematic review. Am J Transplant. 2013; 13(10): 2645–2652.
- Detry O, De Roover A, de Leval L, et al. Transmission of an undiagnosed sarcoma to recipients of kidney and liver grafts procured in a non-heart beating donor. Liver Transpl. 2005; 11(6): 696–699.
- Thoning J, Liu Y, Bistrup C, et al. Transmission of angiosarcomas from a common multiorgan donor to four transplant recipients. Am J Transplant. 2013; 13(1): 167–173.
- Al-Azzawi Y, Stein LL, Shrestha R, et al. Donor-Derived Hepatic Neuroendocrine Tumor: Pause Before Proceeding With Liver Retransplantation. Transplant Direct. 2016; 2(7): e88.
- Mrzljak A, Kocman B, Skrtic A, et al. Liver re-transplantation for donor-derived neuroendocrine tumor: A case report. World J Clin Cases. 2019; 7(18): 2794–2801.
- Kauffman HM, Cherikh WS, McBride MA, et al. Deceased donors with a past history of malignancy: an organ procurement and transplantation network/united network for organ sharing update. Transplantation. 2007; 84(2): 272–274.
- Alsara A, Rafi M. Donor-transmitted melanoma after limbal stem cell transplantation. Avicenna J Med. 2017; 7(2): 75–77.
- Sepsakos L, Cheung AY, Nerad JA, et al. Donor-Derived Conjunctival-Limbal Melanoma After a Keratolimbal Allograft. Cornea. 2017; 36(11): 1415–1418.
- Oerlemans MI, Groenewegen G, Vink A, et al. Donor-derived testicular germ cell cancer in a heart transplant recipient. JACC Cardio Oncol. 2021; 3(2): 322–325.
- Kowal M, Hus M, Dmoszynska A, et al. Acute T cell lymphoblastic leukemia in the recipient of a renal transplant from a donor with malignant lymphoma. Acta Haematol. 2008; 119(3): 187–189.
- Williams T, Aljitawi OS, Moussa R, et al. First case of donor transmitted non-leukemic promyelocytic sarcoma. Leuk Lymphoma. 2012; 53(12): 2530–2534.
- Sosin M, Nassif SR, Girlanda R, et al. Isolated peritoneal donor-related plasmacytoma 3 years after liver transplantation: a case report. Am J Transplant. 2014; 14(2): 472–476.
- Felldin M, Ekberg J, Polanska-Tamborek D, et al. Donor Monoclonal Gammopathy May Cause Lymphoproliferative Disorders in Solid Organ Transplant Recipients. Am J Transplant. 2016; 16(9): 2676–2683.
- Serra N, Revuelta I, Bladé J, et al. Monoclonal gammopathy of undetermined significance: a contraindication for living kidney donation? NDT Plus. 2011; 4(4): 256–257.
- SaBTO (Advisory Committee on the Safety of Blood, Tissues and Organs). Transplantation of organs from deceased donors with cancer or a history of cancer. London: Department of Health 2014 [updated 24 December 2020]. www.gov.uk/government/publications/transplantation-of-organs-from-donors-with-a-history-of-cancer (11 June 2021).
- Detry O, Honore P, HAns MF, et al. Organ donors with primary central nervous system tumor. Transplantation. 2000; 70(1): 244–252.
- Jonas S, Bechstein WO, Lemmens HP, et al. Liver graft-transmitted glioblastoma multiforme. A case report and experience with 13 multiorgan donors suffering from primary cerebral neoplasia. Transpl Int. 1996; 9(4): 426–429.
- Cerame MA, Guthikonda M, Kohli CM. Extraneural metastases in gliosarcoma: a case report and review of the literature. Neurosurgery. 1985; 17(3): 413–418.
- Ruiz JC, Cotorruelo JG, Tudela V, et al. Transmission of glioblastoma multiforme to two kidney transplant recipients from the same donor in the absence of ventricular shunt. Transplantation. 1993; 55(3): 682–683.
- Colquhoun SD, Robert ME, Shaked A, et al. Transmission of CNS malignancy by organ transplantation. Transplantation. 1994; 57(6): 970–974.
- Jonas S, Bechstein WO, Lemmens HP, et al. Liver graft-transmitted glioblastoma multiforme. A case report and experience with 13 multiorgan donors suffering from primary cerebral neoplasia. Transpl Int. 1996; 9(4): 426–429.
- Bosmans JL, Ysebaert D, De Cock AM, et al. Interferon-alpha and the cure of metastasis of a malignant meningioma in a kidney allograft recipient: a case report. Transplant Proc. 1997; 29(1-2): 838.
- Hoffman HJ, Yoshida M, Becker LE, et al. Pineal region tumors in childhood. Experience at the Hospital for Sick Children. 1983. Pediatr Neurosurg. 1994; 21(1): 91–103; discussion 104.