Buell J F, Trofe J, Hanaway M J, Lo A, Rosengard B, Rilo H, Alloway R, Beebe T, First M R, Woodle E S
Israel Penn International Transplant Tumor Registry, Department of Surgery, University of Cincinnati, Ohio 45267, USA.
Surgery. 2001 Oct;130(4):660-6; discussion 666-8. doi: 10.1067/msy.2001.117102.
The demand for transplantable organs exceeds donor supply. Patients with central nervous system (CNS) or other tumors are controversial donors, and the donor cancer transmission rates in cardiothoracic transplant recipients have not been determined. The Israel Penn International Transplant Tumor Registry (IPITTR) was queried to define the risk of donor cancer transmission in cardiothoracic transplant recipients.
All heart, lung, or heart-lung recipients of organs from donors with a history of malignancy were reviewed. Donor and recipient demographics, histologic findings, and recurrence were reviewed.
Twenty-two patients received 17 hearts, 3 lungs, and 2 heart-lung transplants from donors with known CNS or other malignancies. No malignancy transmissions were noted with astrocytomas (n = 3) or glioblastomas (n = 1), except a medulloblastoma that recurred at 6 months. The transmission rate for CNS tumors was 17% (1 of 6), and 1- and 3-year survivals were 67% and 50%, respectively. The most common non-CNS donor cancer was renal cell carcinoma (n = 5). Two renal cell cancer transmissions occurred, both when vascular extension was present. The most aggressive tumor transmission was choriocarcinoma (n = 2) and melanoma (n = 2). Two of 3 choriocarcinomas metastasized with 67% mortality, and both melanomas were transmitted and resulted in death. Other donor cancers included angiosarcoma (n = 2), cervical (n = 1), lung (n = 1), prostate (n = 1), and a liver adenocarcinoma. The transmission rate for all non-CNS groups was 56% (9 of 16) with a 2-year survival of 40%.
The IPITTR experience indicates that tumor transmission is high (10 of 22, 45%) in cardiothoracic transplant recipients. Similar to intra-abdominal organ recipients in the IPITTR, (1) renal cell carcinomas without capsular invasion appear safe with no transmission, (2) vascular invasion in renal cell carcinoma appears to result in early tumor transmission, and (3) melanoma and choriocarcinoma have high rates of transmission with early and almost universal death.
可移植器官的需求超过了供体供应。中枢神经系统（CNS）或其他肿瘤患者作为供体存在争议，心胸移植受者中供体癌症传播率尚未确定。查询以色列宾夕法尼亚国际移植肿瘤登记处（IPITTR）以确定心胸移植受者中供体癌症传播的风险。
对所有接受过有恶性肿瘤病史供体器官的心脏、肺或心肺移植受者进行回顾。回顾供体和受者的人口统计学、组织学结果及复发情况。
22例患者接受了来自已知患有中枢神经系统或其他恶性肿瘤供体的17例心脏、3例肺和2例心肺移植。星形细胞瘤（n = 3）或胶质母细胞瘤（n = 1）未出现恶性肿瘤传播，但有1例髓母细胞瘤在6个月时复发。中枢神经系统肿瘤的传播率为17%（6例中的1例），1年和3年生存率分别为67%和50%。最常见的非中枢神经系统供体癌症是肾细胞癌（n = 5）。发生了2例肾细胞癌传播，均在存在血管侵犯时。最具侵袭性的肿瘤传播是绒毛膜癌（n = 2）和黑色素瘤（n = 2）。3例绒毛膜癌中有2例发生转移，死亡率为67%，2例黑色素瘤均发生传播并导致死亡。其他供体癌症包括血管肉瘤（n = 2）、宫颈癌（n = 1）、肺癌（n = 1）、前列腺癌（n = 1）和肝腺癌。所有非中枢神经系统组的传播率为56%（16例中的9例），2年生存率为40%。
IPITTR的经验表明，心胸移植受者中肿瘤传播率很高（22例中的10例，45%）。与IPITTR中腹部器官移植受者类似，（1）无包膜侵犯的肾细胞癌似乎安全，不会传播；（2）肾细胞癌的血管侵犯似乎会导致早期肿瘤传播；（3）黑色素瘤和绒毛膜癌传播率高，早期几乎普遍死亡。
