Albino Eccher1, Luca Cima1, Andrea Ciangherotti2, Umberto Montin3, Paola Violi3, Amedeo Carraro3, Umberto Tedeschi3, Francesco Nacchia4, Francesca Fior4, Momo Rostand4, Luigino Boschiero4, Antonietta D'Errico5, Aldo Scarpa1, Marilena Casartelli-Liviero6, Giuseppe Ferrari6, Viviana Rodini6, Elisabetta Tomaselli6, Laura Zampicinini6, Francesca Vanzo7, Chiara Bovo8, Giuseppe Feltrin9, Desley Neil10, Matteo Brunelli1. 1. Pathology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy. 2. Department of Surgical Science, General and Hepatobiliary Surgery, University and Hospital Trust of Verona, Verona, Italy. 3. Liver Transplant Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy. 4. Department of Surgical Science, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy. 5. Pathology Unit, Department of Specialised, Experimental and Diagnostic Medicine, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy. 6. Neurosurgery and Intensive Care Unit, Department of Surgical Science, University and Hospital Trust of Verona, Verona, Italy. 7. Arsenàl, Veneto's Research Center for eHealth Innovation, Veneto, Italy. 8. Medical Direction, University and Hospital Trust of Verona, Verona, Italy. 9. Transplant Regional Center, Veneto Region, Hospital Trust of Padova, Padova, Italy. 10. Pathology Unit, Department of Histopathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Abstract
BACKGROUND: Prevention of transmission of malignancy from donors to recipients is an aim of donor assessment. We report the most stringent interpretation of the Italian National Guidelines. METHODS: A two-step ALERT process was used: ALERT1 consisting of clinical, radiological, and laboratory tests; ALERT2, consisting of intraoperative assessment in suspicious lesions. RESULTS: Four hundred of 506 potential deceased donors entered the ALERT system. Forty-one of 400 (10%) donors were excluded due to unacceptable risk of transmission. Of the remaining 359 193 required histopathology, which excluded malignancy or determined acceptable risk in 161/193 (83%). Thirty-five malignancies were identified: 19 (54%) at ALERT1, four (11%) at ALERT2, nine (26%) picked up at ALERT1 and confirmed by ALERT2. Three (9%) were missed by ALERT and diagnosed at postmortem examination. Prostate (n=12%, 34%) and renal cell (n=7%, 20%) were the most frequent carcinomas. The majority (92%) of prostate adenocarcinomas were of low risk and donation proceeded compared to 43% of renal carcinomas. Four renal carcinomas, two breast carcinomas, and a single case of nine different malignancies excluded donation. Positive ALERT donors had statistically more malignant reports than negative ALERT donors (P=<.05). CONCLUSION: Histopathology is an essential component of the multidisciplinary assessment of donors.
BACKGROUND: Prevention of transmission of malignancy from donors to recipients is an aim of donor assessment. We report the most stringent interpretation of the Italian National Guidelines. METHODS: A two-step ALERT process was used: ALERT1 consisting of clinical, radiological, and laboratory tests; ALERT2, consisting of intraoperative assessment in suspicious lesions. RESULTS: Four hundred of 506 potential deceased donors entered the ALERT system. Forty-one of 400 (10%) donors were excluded due to unacceptable risk of transmission. Of the remaining 359 193 required histopathology, which excluded malignancy or determined acceptable risk in 161/193 (83%). Thirty-five malignancies were identified: 19 (54%) at ALERT1, four (11%) at ALERT2, nine (26%) picked up at ALERT1 and confirmed by ALERT2. Three (9%) were missed by ALERT and diagnosed at postmortem examination. Prostate (n=12%, 34%) and renal cell (n=7%, 20%) were the most frequent carcinomas. The majority (92%) of prostate adenocarcinomas were of low risk and donation proceeded compared to 43% of renal carcinomas. Four renal carcinomas, two breast carcinomas, and a single case of nine different malignancies excluded donation. Positive ALERT donors had statistically more malignant reports than negative ALERT donors (P=<.05). CONCLUSION: Histopathology is an essential component of the multidisciplinary assessment of donors.
Authors: Albino Eccher; Amedeo Carraro; Ilaria Girolami; Manuela Villanova; Alex Borin; Paola Violi; Barbara Paro; Claudia Mescoli; Deborah Malvi; Luca Novelli; Antonietta D'Errico; Giuseppe Rossini; Marco Ungari Journal: Am J Case Rep Date: 2021-02-13
Authors: James A Hedley; Patrick J Kelly; Karen M J Waller; Imogen K Thomson; Nicole L De La Mata; Brenda M Rosales; Kate Wyburn; Angela C Webster Journal: Transplant Direct Date: 2022-01-13