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

Girolami, Ilaria, Neil, Desley A H, Segev, Dorry Lidor, Furian, Lucrezia, Zaza, Gianluigi, Boggi, Ugo, Gambaro, Giovanni, De Feo, Tullia, Casartelli-Liviero, Marilena, Cardillo, Massimo, Lombardini, Letizia, Zampicinini, Laura, D'Errico, Antonietta and Eccher, Albino (2021) Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment. Transplantation reviews (Orlando, Fla.), 35 (2). p. 100608. ISSN 1557-9816.

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Abstract

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.

Item Type: Article
Subjects: QZ Pathology. Oncology
Divisions: Clinical Support > Pathology
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Depositing User: Mr Philip O'Reilly
Date Deposited: 10 Mar 2021 14:16
Last Modified: 10 Mar 2021 14:16
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4064

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