Premium
Rapid screening for malignancy in organ donors: 15‐year experience with the Verona “Alert” protocol and review of the literature
Author(s) -
Eccher Albino,
Cima Luca,
Ciangherotti Andrea,
Montin Umberto,
Violi Paola,
Carraro Amedeo,
Tedeschi Umberto,
Nacchia Francesco,
Fior Francesca,
Rostand Momo,
Boschiero Luigino,
D'Errico Antonietta,
Scarpa Aldo,
CasartelliLiviero Marilena,
Ferrari Giuseppe,
Rodini Viviana,
Tomaselli Elisabetta,
Zampicinini Laura,
Vanzo Francesca,
Bovo Chiara,
Feltrin Giuseppe,
Neil Desley,
Brunelli Matteo
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13045
Subject(s) - medicine , malignancy , histopathology , organ donation , transplantation , gynecology , surgery , pathology
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: ALERT 1 consisting of clinical, radiological, and laboratory tests; ALERT 2, 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 ALERT 1, four (11%) at ALERT 2, nine (26%) picked up at ALERT 1 and confirmed by ALERT 2. 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.