Mensink Jacobus W, Pol Robert A, Nijboer Wijmtje N, Erasmus Michiel E, de Jonge Jeroen, de Vries Kirsten M, van der Jagt Michel F, van der Kaaij Niels P, van de Poll Marcel C G, Alwayn Ian P J, Braat Andries E
Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
Department of Organ and Tissue Donation, Dutch Transplant Foundation, Leiden, The Netherlands.
Transplant Direct. 2019 Nov 15;5(12):e509. doi: 10.1097/TXD.0000000000000953. eCollection 2019 Dec.
In most western countries, the median donor age is increasing. The incidence of malignancies in older populations is increasing as well. To prevent donor-derived malignancies we evaluated radiologic donor screening in a retrospective donor cohort.
This study analyzes the efficacy of a preoperative computed tomography (CT) scan on detecting malignancies. All deceased organ donors in the Netherlands between January 2013 and December 2017 were included. Donor reports were analyzed to identify malignancies detected before or during organ procurement. Findings between donor screening with or without CT-scan were compared.
Chest or abdominal CT-scans were performed in 17% and 18% of the 1644 reported donors respectively. Screening by chest CT-scan versus radiograph resulted in 1.5% and 0.0% detected thoracic malignancies respectively. During procurement no thoracic malignancies were found in patients screened by chest CT compared with 0.2% malignancies in the radiograph group. Screening by abdominal CT-scan resulted in 0.0% malignancies, compared with 0.2% in the abdominal ultrasound group. During procurement 1.0% and 1.3% malignancies were found in the abdominal CT-scan and ultrasound groups, respectively.
Screening by CT-scan decreased the perioperative detection of tumors by 30%. A preoperative CT-scan may be helpful by providing additional information on (aberrant) anatomy to the procuring or transplanting surgeon. In conclusion, donor screening by CT-scan could decrease the risk of donor-derived malignancies and prevents unnecessary procurements per year in the Netherlands.
在大多数西方国家，供体的年龄中位数在增加。老年人群中恶性肿瘤的发病率也在上升。为预防供体来源的恶性肿瘤，我们对一个回顾性供体队列进行了放射学供体筛查评估。
本研究分析了术前计算机断层扫描（CT）对检测恶性肿瘤的有效性。纳入了2013年1月至2017年12月期间荷兰所有已故器官供体。分析供体报告以确定在器官获取前或获取期间检测到的恶性肿瘤。比较了有无CT扫描的供体筛查结果。
在1644名报告的供体中，分别有17%和18%进行了胸部或腹部CT扫描。胸部CT扫描与X线片筛查分别检测到1.5%和0.0%的胸部恶性肿瘤。在获取过程中，胸部CT筛查的患者未发现胸部恶性肿瘤，而X线片组为0.2%。腹部CT扫描检测到0.0%的恶性肿瘤，而腹部超声组为0.2%。在获取过程中，腹部CT扫描组和超声组分别发现1.0%和1.3%的恶性肿瘤。
CT扫描筛查使围手术期肿瘤检测率降低了30%。术前CT扫描可为获取或移植外科医生提供有关（异常）解剖结构的额外信息，可能会有所帮助。总之，CT扫描供体筛查可降低荷兰供体来源恶性肿瘤的风险，并防止每年不必要的获取。
