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Fundamentals to Complex decisions with kidney transplantation

1892.1 - Fundamentals to Complex decisions with kidney transplantation

Presenter: Milagros, Samaniego Picota, ,
Authors:

Overview

This overview will focus on donor-derived malignancies. Donors with history of malignancies or with an incidental finding of malignancy during procurement are usually ruled out for donation and their organs are discarded.

The imbalance between the offer and demand of organs for patients with end stage disease has led to the proposal of exploring the acceptance of donors with history of malignancies.

When accepting a donor with cancer risk one must consider the risk:benefit ratio to the recipient of developing a donor-related malignancy versus staying on dialysis, the type of tumor and its natural history, and whether the tumor is curable or amenable of treatment.

We will discuss the natural history of patients that have received transplants from donors with a history of malignancy;  review donor malignancies that are suitable for organ transplantation and those that are absolutely contraindicated; and the guidelines for work-up of living donors with history of malignancy and choice of organs in patients with an incidental finding of cancer.

Learning Objective

  1. Review the epidemiology of donor-transmitted malignancy in solid-organ transplantation.
  2. Discuss the outcomes of recipients of transplants from donor-derived malignancy.
  3. Risk to benefit ratio: selecting transplant candidates that may benefit from receiving organs from donors with history of malignancy.
  4. Define the donor malignancies acceptable and unacceptable for transplantation.
  5. Enumerate the International and Societies guidelines for the work-up of donors with history of cancer, evaluation of cancer-risk deceased donors and recipients of transplants from donors with cancer risk.

Suggested Reading

  1. Desai R et al: BJS 2014; 101: 768–774.
  2. Baudoux T.E.R et al: Kidney International Reports (2017) 2, 134–137.
  3. Report of SABTO Advisory Committee on the Safety of Blood, Tissue and Organs (2014).
  4. Hassanaim M: Ann Transplant, 2014; 19: 241-247.
  5. Zhang S et al: Transplantation Reviews 28 (2014) 169–175.
  6. Kinch A et al: Am J Transplant 2014; 14: 2838–2845 2839.
  7. Ma MKM et al: Transplantation 2014;98: 1286Y1293.
  8. Engels EA et al: Am J Transplant 2014; 14: 1376–1382.
  9. Narvaez JRF et al: Am J Transplant. 2018 Nov;18(11):2708-2718.
  10. Cui CB and Garber DA: J Clin Invest. 2013;123(9):3708–3709.

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