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ISN-TTS Webinar - Monday, November 23, 2020 - 2:30PM CET (8:30AM Montreal time)

“Fundamentals to Complex decisions with kidney transplantation”
Donor/Recipient pair - Risks vs. Gains - Cancer

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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.

Speaker:
Milagros Samaniego Picota

International Society of Nephrology (Member)
Transplantation Society
American Society of Nephrology
American Society of Transplantation
National Kidney Foundation
American College of Physicians


Dr. Millie Samaniego is a transplant nephrologist with 20 years of experience in immunopathology and clinical transplantation.  Dr. Samaniego graduated from the University of Panama School of Medicine and continued post-graduate training in Internal Medicine at Baylor College of Medicine in Houston, TX. She completed Fellowship training in Nephrology and Immunopathology at the Johns Hopkins School of Medicine and joined the original team of the Johns Hopkins Incompatible Kidney Transplant Program.  Through this work, she gained expertise in desensitization protocols, management of sensitized patients, patients with acute and chronic transplant antibody injury, and the use of histocompatibility techniques in the clinic.

After leaving Johns Hopkins, she was Associate Professor and Professor at the University of Wisconsin and the University of Michigan, respectively; and developed desensitization programs in both institutions. During her tenure at the University of Michigan, she was the first Alan B. Leichtman Collegiate Chair of Transplant Nephrology.

Dr. Samaniego has been medical director of two kidney and pancreas transplant programs – The University of Michigan from 2009-2017 and the Henry Ford Transplant Institute since 2018.  

As a researcher, she has been Co-Principal Investigator in several NIH consortium grants including GoCAR (PO1), CTOT-09, CTOT-19 and CTOT-21; and co-investigator in many pharmaceutical trials. 

Dr. Samaniego is a former Associate Editor of the American Journal of Transplantation, and ad-hoc reviewer in many nephrology and transplantation journals.  She has had leadership roles in the ASN, AST, NKF and the Transplantation Society.  She has authored over 100 original manuscripts, and an invited speaker in many national and international meetings.

Moderator:
Jesse Schold PhD, M.Stat., M.Ed.

Cleveland
Clinic Cleveland,
Ohio USA


Dr. Jesse Schold, PhD, M.Stat., M.Ed. is a Full Staff member in the Department of Quantitative Health Sciences in the Health Outcomes Research and Clinical Epidemiology Section and Director of the Center for Populations Health Research at the Lerner Research Institute at the Cleveland Clinic. Dr. Schold’s research interests include health services research, access to healthcare and statistical and epidemiological methods. Dr. Schold has co-authored over 260 peer-reviewed scientific publications with primary focus in organ transplantation. He has served on numerous national committees and a co-investigator on multiple federal grants. 

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