Donor-related malignancies

Donor-related malignancies have been intermittently reported since the beginning of human organ transplantation. Although reported mortality is high, cases of tumor regression after cessation of immunosuppression have been recorded. Data reported to the Transplant Tumor Registry of the United Network for Organ Sharing/Organ Procurement and Transplantation Network database allow calculation of donor-related cancer incidence. In a cohort of 34,933 cadaveric organ donors that yielded 108,062 organ transplants, there were 14 donors with malignancies that resulted in 18 donor-related tumors. The donor-related tumor rate (14/34,933) is 0.04%, and the organ-related tumor rate (18/ 108,062) is 0.017%. Donor-related tumors have been classified as donor-transmitted tumors, in which the malignant cells were transferred with the donor organ to the recipient, and donor-derived tumors, which are de novo tumors that develop in donor hematologic or lymphoid cells that accompany the transplanted organ. There were 13 donor-transmitted tumors (13/108,062), for a donor transmission rate of 0.012%. Six of the 13 recipients of donor-transmitted tumors died from the tumor, resulting in a tumor transmission (6/108,062) death rate of 0.005%. Reports of and problems with specific donor-related tumors such as malignant melanoma, choriocarcinoma, primary central nervous system malignancies, renal tumors, carcinoma of the lung, Kaposi's sarcoma, and hematologic and lymphomatous malignancies are detailed. Strategies for prevention of donor-related malignancies are described, as well as treatment options for recipients with donor-related tumors.