Birkeland Sven Arvid, Storm Hans H
Department of Nephrology, Odense University Hospital, Odense, Denmark.
Transplantation. 2002 Nov 27;74(10):1409-13. doi: 10.1097/00007890-200211270-00012.
Organ donation may involve the risk of transmittal of unwanted host factors such as infections and malignancy. These may be concealed in the emergent donation process. It may be unavoidable if first observed in a donor postmortem. A number of reports on transferred cancers have been published, but quantification of the risk has never been reliably performed. We report here the first population-based analysis of unrecognized malignancies and other diseases in cadaveric or living-related donors and the possible consequences for the recipients.
We compiled a cohort of all organ donors through 27 years (1969-1996) in one single kidney transplant center covering a population on one million people. This cohort was linked to the Danish Cancer Registry, the Danish National Hospital Register, and the Danish Register of Causes of Death by means of the unique personal identification number, and all cancers, diagnosis from hospital admissions, and causes of death were identified. Follow-up was to the end of 1996.
A total of 626 donors (491 cadaveric and 135 living-related donors) was included in the study. Ten carcinoma in situ or dysplasia cervix uteri (by definition nonmalignant), and 13 malignant tumors (5 of these were detected in living-related donors after donation) were detected by linkage to the cancer registry. All together, 17 recipients received organs from donors with carcinoma in situ or dysplasia cervix uteri and 20 from donors with malignancies. Two recipients from organ donors with carcinoma in situ or dysplasia of the cervix uteri and two recipients from donors with malignancies had a cancer detected; however, these were likely unrelated. One died 1 year after transplantation from a melanoma transmitted from the donor. Two cadaveric donors had previous admissions for glomerulonephritis, five for pyelonephritis, five for nephrolithiasis or ureterolithiasis, four for cystitis, and one for hydronephrosis.
Despite all efforts to secure a safe organ for transplantation, transmission of donor malignancy and other diseases nevertheless can happen, as is recorded many times in the literature. We have quantified the risk using the population-based cancer registry and found a risk of 8 in 626 (1.3%) for having a donor with undetected malignancy and a risk of 1 in 626 (0.2%) for transmitting a cancer. The risk for getting some transmitted glomerulonephritis is 2 in 626 (0.3%). None of the donors with cerebral malignancies transmitted any tumors to the recipients. Compared with the benefits of organ transplantation, these risks are small; however, if time allows, a search for additional medical information from registries could further minimize the risk of transmission of malignancies or other diseases. However, this requires updated, accurate, and accessible registries and legislation that allows access to personal data and transmission of such data across administrative borders.
器官捐赠可能涉及传播不良宿主因素的风险，如感染和恶性肿瘤。这些因素可能在紧急捐赠过程中被隐匿。如果在供体死后首次发现，可能无法避免。关于转移性癌症已有多篇报道，但风险量化从未得到可靠执行。我们在此报告首例基于人群的尸体或亲属活体供体中未被识别的恶性肿瘤及其他疾病分析，以及对受者可能产生的后果。
我们汇总了一个单一肾脏移植中心27年（1969 - 1996年）内的所有器官供体队列，该中心覆盖人群达100万。通过唯一的个人识别码，将该队列与丹麦癌症登记处、丹麦国家医院登记处以及丹麦死亡原因登记处相链接，识别出所有癌症、医院入院诊断及死亡原因。随访至1996年底。
该研究共纳入626名供体（491名尸体供体和135名亲属活体供体）。通过与癌症登记处链接，检测到10例子宫颈原位癌或发育异常（根据定义为非恶性）以及13例恶性肿瘤（其中5例在亲属活体供体捐赠后被检测到）。共有17名受者接受了来自子宫颈原位癌或发育异常供体的器官，20名受者接受了来自患有恶性肿瘤供体的器官。两名接受子宫颈原位癌或发育异常供体器官的受者以及两名接受患有恶性肿瘤供体器官的受者被检测出患有癌症；然而，这些癌症可能与供体无关。一名受者在移植后1年因供体传播的黑色素瘤死亡。两名尸体供体曾因肾小球肾炎入院，5名因肾盂肾炎入院，5名因肾结石或输尿管结石入院，4名因膀胱炎入院，1名因肾积水入院。
尽管尽一切努力确保移植器官的安全，但供体恶性肿瘤及其他疾病的传播仍可能发生，正如文献中多次记载的那样。我们利用基于人群的癌症登记处对风险进行了量化，发现供体存在未被检测出的恶性肿瘤的风险为626例中有8例（1.3%），癌症传播风险为626例中有1例（0.2%）。感染传播性肾小球肾炎的风险为626例中有2例（约0.3%）。患有脑恶性肿瘤的供体均未向受者传播任何肿瘤。与器官移植的益处相比，这些风险较小；然而，如果时间允许，从登记处查找更多医疗信息可进一步降低恶性肿瘤或其他疾病传播的风险。然而，这需要更新、准确且可访问的登记处以及允许获取个人数据并跨行政边界传输此类数据的立法。
