Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment.


Journal

Transplantation reviews (Orlando, Fla.)
ISSN: 1557-9816
Titre abrégé: Transplant Rev (Orlando)
Pays: United States
ID NLM: 8804364

Informations de publication

Date de publication:
04 2021
Historique:
received: 23 10 2020
revised: 07 02 2021
accepted: 08 02 2021
pubmed: 2 3 2021
medline: 29 10 2021
entrez: 1 3 2021
Statut: ppublish

Résumé

clinical and imaging investigations allow a detailed assessment of an organ donor, but a quota of cancer still elude detection. Complete autopsy of donors is even less frequently performed, due to economic issues and increasing availability of high-quality imaging. The aim of this study is to gather evidence from the literature on donor malignancy discovered at autopsy following organ donation and to discuss the utility and limitations of autopsy practice in the field of transplantation. A systematic search according to PRISMA guidelines was carried out in Pubmed and Embase databases until September 2020 to select articles with reporting of cancer discovered in a donor at postmortem examination. Cancer discover in not-transplant setting were excluded. A descriptive synthesis was provided. Of 7388 articles after duplicates removal, 56 were included. Fifty-one studies reported on complete autopsy, while 5 dealt only with limited autopsy (prostate and central nervous system). The number of autopsies ranged between 1 and 246 with a total of 823 autopsies performed. The most frequent cancer discovered at autopsy was lymphoma (n = 13, 15%), followed by renal cell carcinoma (RCC) (n = 11, 13%), non-small cell lung cancer (NSCLC) (n = 10, 11%), melanoma (n = 10, 11%), choriocarcinoma (n = 6, 7%) and glioblastoma (GBM) (n = 6, 7%). Lymphoma and melanoma are still difficult-to-detect cancers both during donor investigation and at procurement, whilst prostate cancer and choriocarcinoma are almost always easily detected nowadays thank to blood markers and clinical examination. There have been improvements with time in pre-donation detection procedures which are now working well, particularly when complete imaging investigations are performed, given that detection rate of CT/MRI is high and accurate. Autopsy can play a role to help to establish the correct donor management pathways in case of cancer discover. Furthermore, it helps to better understand which cancers are still eluding detection and consequently to refine guidelines' assessment procedures.

Sections du résumé

BACKGROUND
clinical and imaging investigations allow a detailed assessment of an organ donor, but a quota of cancer still elude detection. Complete autopsy of donors is even less frequently performed, due to economic issues and increasing availability of high-quality imaging. The aim of this study is to gather evidence from the literature on donor malignancy discovered at autopsy following organ donation and to discuss the utility and limitations of autopsy practice in the field of transplantation.
METHODS
A systematic search according to PRISMA guidelines was carried out in Pubmed and Embase databases until September 2020 to select articles with reporting of cancer discovered in a donor at postmortem examination. Cancer discover in not-transplant setting were excluded. A descriptive synthesis was provided.
RESULTS
Of 7388 articles after duplicates removal, 56 were included. Fifty-one studies reported on complete autopsy, while 5 dealt only with limited autopsy (prostate and central nervous system). The number of autopsies ranged between 1 and 246 with a total of 823 autopsies performed. The most frequent cancer discovered at autopsy was lymphoma (n = 13, 15%), followed by renal cell carcinoma (RCC) (n = 11, 13%), non-small cell lung cancer (NSCLC) (n = 10, 11%), melanoma (n = 10, 11%), choriocarcinoma (n = 6, 7%) and glioblastoma (GBM) (n = 6, 7%).
CONCLUSIONS
Lymphoma and melanoma are still difficult-to-detect cancers both during donor investigation and at procurement, whilst prostate cancer and choriocarcinoma are almost always easily detected nowadays thank to blood markers and clinical examination. There have been improvements with time in pre-donation detection procedures which are now working well, particularly when complete imaging investigations are performed, given that detection rate of CT/MRI is high and accurate. Autopsy can play a role to help to establish the correct donor management pathways in case of cancer discover. Furthermore, it helps to better understand which cancers are still eluding detection and consequently to refine guidelines' assessment procedures.

Identifiants

pubmed: 33647551
pii: S0955-470X(21)00014-8
doi: 10.1016/j.trre.2021.100608
pii:
doi:

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

100608

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None.

Auteurs

Ilaria Girolami (I)

Division of Pathology, Central Hospital Bolzano, Bolzano, Italy.

Desley Neil (D)

Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Dorry Lidor Segev (DL)

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Lucrezia Furian (L)

Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University and Hospital Trust of Padua, Padua, Italy.

Gianluigi Zaza (G)

Renal Unit, University and Hospital Trust of Verona, Verona, Italy.

Ugo Boggi (U)

Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.

Giovanni Gambaro (G)

Renal Unit, University and Hospital Trust of Verona, Verona, Italy.

Tullia De Feo (T)

North Italy Transplant Program, Coordinamento Trapianti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.

Marilena Casartelli-Liviero (M)

Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy.

Massimo Cardillo (M)

National Transplant Center, Rome, Italy.

Letizia Lombardini (L)

National Transplant Center, Rome, Italy.

Laura Zampicinini (L)

Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy.

Antonietta D'Errico (A)

Pathology Unit, University of Bologna, IRCCS Policlinico St. Orsola-Malpighi Hospital, Bologna, Italy.

Albino Eccher (A)

Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy. Electronic address: albino.eccher@aovr.veneto.it.

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Classifications MeSH