Background: Transmission (TX) of cancer is a rare but life-threatening complication of transplantation. Most cancers preclude donation, but some may be missed if an accurate history is difficult to obtain, e.g., remote cancers in deceased donors (DD). Living donors (LD) with pre-clinical malignancies may also pose risk. Cancer registry data can inform understanding of TX risk.

Methods: We linked the U.S. solid organ transplant registry with 15 state/regional cancer registries to identify cancers in donors and recipients (204,946 transplants, 1987-2009). Poisson regression compared cancer incidence in recipients according to donor cancer status. We also reviewed case listings for possible TX based on concordance of rare malignancies or tumor cell type in donors and recipients.

Results: Cancer registries identified cancer in 1360 donors (1.1% of donors: 461 DD, 899 LD). Among DD, 56% of cancers were diagnosed (dx’ed) within 1 yr of donation, 29% were dx’ed >5.0 yrs before donation, and 55% were brain tumors. Among LD, 81% of cancers were dx’ed after donation, while 5%, 3%, and 10% were dx’ed 0-2.0 yrs, 2.1-5.0, and >5.0 yrs before donation; cancers were typically those common in the general population (e.g., breast, prostate). Compared to recipients whose donors did not have cancer, recipients of donors with cancer did not have significantly increased cancer incidence themselves, considering all DD with cancer (incidence rate ratio 1.17, 95%CI 0.92-1.47), DD with brain tumors (1.08, 0.80-1.42), or LD with cancer (1.04, 0.78-1.37). Nonetheless, we noted 2 suggestive TX events, which had not been reported to the transplant registry. A kidney LD developed multiple myeloma (MM) 9 mo post-donation; his recipient developed MM 1.8 yr post- transplant. In another case, a kidney LD had melanoma 14 yr pre-donation; the recipient developed melanoma 6 yr post-transplant.

Discussion: Cancer registries can identify donor cancers, which may be remote and unknown to transplant providers. Although such cancers were not associated with increased cancer risk in recipients, statistical analyses may have limited ability to detect TX. TX of melanoma even after a long cancer-free period, has been described previously and may have occurred in a case described here. MM is preceded by a prolonged asymptomatic precursor condition, and the other case we describe may be the first reported donor TX of this malignancy. DD and LD should be carefully evaluated for cancer and precancerous conditions before transplantation, and incident cancers in LD should be reported back to transplant centers.

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