Donor transmitted and de novo cancer after liver transplantation

Abstract

Cancers in solid organ recipients may be classified as donor transmitted, donor derived, de novo or recurrent. The risk of donor-transmitted cancer is very low and can be reduced by careful screening of the donor but cannot be abolished and, in the United Kingdom series is less than 0.03%. For donors with a known history of cancer, the risks will depend on the nature of the cancer, the interventions given and the interval between diagnosis and organ donation. The risks of cancer transmission must be balanced against the risks of death awaiting a new graft and strict adherence to current guidelines may result increased patient death. Organs from selected patients, even with high-grade central nervous system (CNS) malignancy and after a shunt, can, in some circumstances, be considered. Of potential donors with non-CNS cancers, whether organs may be safely used again depends on the nature of the cancer, the treatment and interval. Data are scarce about the most appropriate treatment when donor transmitted cancer is diagnosed: sometimes substitution of agents and reduction of the immunosuppressive load may be adequate and the impact of graft removal should be considered but not always indicated. Liver allograft recipients are at increased risk of some de novo cancers, especially those grafted for alcohol-related liver disease and hepatitis C virus infection. The risk of lymphoproliferative disease and cancers of the skin, upper airway and bowel are increased but not breast. Recipients should be advised to avoid risk behavior and monitored appropriately.

Keywords: Liver transplantation, Cancer, Donor transmitted cancer, De novo cancer, Immunosuppression

Core tip: Cancer is an important cause of morbidity and mortality after organ transplantation. Donor transmitted cancers are rare but when they occur, they can have significant impact on the recipient outcome. Screening of donors can reduce the risk of transmission of cancer but cannot eliminate it. So this risk should be accepted by the transplant teams and the recipients. The risk of many de novo cancers is increased among transplant recipients. Selection of immunosuppressive agents, minimizing the intensity of immunosuppression and modification of life-style related risk factors would contribute to reduction of the risk of post-transplant cancer.