Inadvertently Transmitted Malignancies

Immunosuppressive therapy may permit cancer cells inadvertently transmitted with donor organs to survive, multiply and metastasize.1,2 Most transmitted neoplasms occurred in the pioneering era of transplantation, when the danger of grafting organs from donors with cancer into immunosuppressed recipients was not appreciated. Today inadvertent transplantation of organs containing tumor cells is a rare event. However, several cases of per annum do occur despite the most stringent selection criteria used by organ procurement teams. By November, 1997, the CTTR had received data on 279 patients who received organs from donors with malignancies.1,2 The great majority received kidney allografts and the remainder had hepatic, cardiac, pancreatic, pulmonary or cardiopulmonary allografts. Eighty-three percent of donors were cadavers and, of these more than one third provided two or more organs to the recipients. Fifteen percent of donors were living related individuals who had been treated for malignancy within 10 years of donation, or were found to have cancer at the time of donation, or manifested evidence of one within 18 months of the procedure. Another 2% of donors were living unrelated individuals.

The cause of brain death was misdiagnosed in 27 cadaver donors (involving organs transplanted into 56 recipients). Cerebral metastases, particularly from choriocarcinomas, carcinomas of the bronchus, and malignant melanomas either masqueraded as primary brain tumors, or bled and mimicked hemorrhage from a cerebral aneurysm or arteriovenous malformation.

In the overall series 43% of allografts had evidence of cancer.1,2 In nine instances these were small primary tumors of a renal allograft which were widely

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