Protected: Can Patients with History of Malignancy Become Organ Donors?

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Prof. Antonio Amoroso

Centro Regionale Trapianti Regione Piemonte e
SC Immunogenetica e Biologia dei Trapianti
Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino

Corresponding author:
Antonio Amoroso
Via Santena, 19 - 10126 Torino – Italy
E-mail: antonio.amoroso@unito.it
http://www.trapiantipiemonte.it/

 

Abstract

Cancer transmission from solid organ donors to recipients is a known risk factor in transplantation. The Italian National Network for Transplantation (CNT) has adopted specific guidelines to evaluate the suitability of donors with history of malignancy. CNT also provides a Second Opinion service to assess oncological cases with a potential risk of neoplastic transmission to the recipient. CNT aims to minimize the risk of disease transmission from donors to recipients.

According to CNT guidelines, “standard” donors are defined as individuals with no signs of active malignancy and no history of cancer at the time of organ procurement. Unsuitable donors, defined as those with an “unacceptable risk”, are those patients with evidence of malignancy at the time of donation or in their medical history that carries an unacceptably high risk of disease transmission. Between these two categories, a broad spectrum of “non-standard” donors exists, where the risk of transmission is not entirely absent, but remains low enough to consider organ utilization. Malignancy should not be considered an absolute contraindication for organ donation.

CNT has also adopted a specific repository for adverse events (AE) after transplantation. Since 2012, with 10.493 donors and 34.193 performed transplants, 283 AE have been recorded, occurring in approximately 3% of donation processes and 1% of performed transplants. Oncological AE represented 13% of all reports. In the majority of cases, oncological AE resulted from missed diagnosis during organ procurement, benchwork, or transplantation surgery.

CNT guidelines, the oncological second opinion service, and the repository helped minimize the risk of cancer transmission with transplantation.

Keywords: cancer, organ donor, transplant

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Protected: Transplant Candidate with Cancer: Should We Proceed?

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Giacomo Mascia1*, Matteo Floris1*, Andrea Angioi1, Nicola Lepori1, Davide Argiolas1, Gianfranca Cabiddu1,2 e Antonello Pani1,2

1 S.C. Nefrologia a Dialisi, Ospedale G. Brotzu, Cagliari, Italia
2 Università degli Studi di Cagliari, Dipartimento di Scienze Mediche, Cagliari, Italia
Gli autori contrassegnati con * hanno contribuito in maniera uguale alla pubblicazione

Corresponding author:
Antonello Pani, M.D.
Divisione di Nefrologia e Dialisi,
Azienda Ospedaliera G. Brotzu, Cagliari, Italy
Email: antonellopani@aob.it
Phone: +39070539496

 

Abstract

Individuals who suffer from end-stage renal disease are at a higher risk of developing certain types of tumors. This risk increases as kidney function deteriorates further. Dialysis patients often witness a surge in the incidence of such malignancies. Interestingly, after the initial period following a kidney transplant, there is a dip in the number of deaths related to neoplasms. However, a long-term view reveals a progressive increase in the risk of developing tumors. The evaluation process for transplant candidacy is thorough, taking into account several factors, including the individual’s history of neoplasms and the implications of immunosuppressive therapy. Immunosuppressive therapy is a double-edged tool in managing post-transplant complications, as it can foster environments conducive to neoplasm growth. It is essential to reevaluate, with the aid of an oncological opinion, the waiting time between cancer recovery and the listing for kidney transplantation, based on clinical data and follow-up. Independent of the type of tumor, the requirement to treat and achieve remission delays the listing process, consequently extending the time spent with end-stage renal disease and undergoing dialysis. These factors correlate with increased mortality, heightened risk of cardiovascular disease, and graft loss.

Keywords: Kidney transplant, cancer, immunosuppressant agents

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Protected: Exploring Tyrosine Kinase Inhibitor (TKI)-Induced Nephrotoxicity: An Emerging Issue from Bench to Bedside

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Debora Collotta1, Eleonora Aimaretti2, Massimo Collino1

1 Department of Neuroscience “Rita Levi-Montalcini”, University of Turin, Turin, Italy
2 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

Corresponding author:
Massimo Collino,
Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino -Cherasco n. 15 – 10126 Torino
e-mail: massimo.collino@unito.it

 

Abstract

Tyrosine Kinase Inhibitors (TKIs) have significantly contributed to revolutionizing cancer treatment, as they are orally administered small molecules able to target key pathways involved in tumor growth and angiogenesis. However, the clinical utility of TKIs may be compromised by adverse effects, which can affect tissues and organs, including kidneys. This comprehensive review offers a general overview of studies reporting the incidence and clinical characteristics of TKI-related nephrotoxicity and it explores the mechanisms underlying the intricate relationship between TKIs and renal toxicity. The biological rationale for the kidney manifestations of toxicity associated with TKI agents is here discussed, underlying potential off-target effects and emphasizing the importance of accurate risk assessment and tailored patient management strategies.

Deep insight into the molecular mechanisms of TKI nephrotoxicity will help to improve the global understanding of the pathophysiology of this peculiar toxicity and to develop more effective and safer therapies.

Keywords: Tyrosine kinase inhibitors, kidney, renal toxicity, cancer

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Protected: Management of Chemotherapy in Patients Subjected in Chronic Dialysis Treatment

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Pirovano Marta1, Re Sartò Giulia Vanessa1, Cosmai Laura1

1 Ambulatorio di Onconefrologia, UOC Nefrologia Dialisi ASST Fatebenefratelli Sacco

Corresponding author:
Laura Cosmai
ASST Fatebenefratelli Sacco – via G.B Grassi, 74
e-mail: lacos@iol.it

 

Abstract

The incidence of tumors is increased in patients with chronic renal failure and even more in patients on dialysis. Dialysis can affect both therapy and prognosis of oncological patients. It increases both cancer-related and non-cancer-related mortality rates and is the main cause of a suboptimal use of therapies. In patients with renal impairment, the dosage of many chemotherapies should be reduced but, due to the lack of real knowledge of the pharmacokinetic and pharmacodynamic properties of these drugs in dialysis, dosage adjustments are often done empirically and most often avoided.

Although many papers are available in the literature regarding chemotherapy in dialysis, there is a lack of consensus regarding drug dosages and administration schedules. Furthermore, guidelines are absent due to the lack of “evidence” for most of these patients, usually excluded from experimental treatments.

Specific onconephrologic trials are therefore mandatory to decide how much, how, and when to use chemotherapy in patients on dialysis and thereby ensure adequate treatment for these patients.

Keywords: onconephrology, dialysis, cancer, chemotherapy

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