5 people transplanted 4 people with cancer, the safety of organ transplantation was seriously tested

On July 6, 2018, the American Transplant Journal published a "special" case report on organ transplantation. An organ donor provided transplanted organs to 5 patients, and 4 patients were found to have breast cancer after surgery, and 3 of them died due to the spread of cancer cells. Expert studies have confirmed that breast cancer from four recipients is derived from donor organs.

The donor of the donor organ was a 53-year-old woman who died of bleeding through the subarachnoid space. According to the organ transplant report of the European Transplant Association before the organ donation, the donor did not have a history of breast cancer before his death, and he did not have any malignant tumor symptoms or other abnormal findings until his death. However, the four patients who received the donation suffered from breast cancer within 16 to 6 years after transplantation. After DNA marker testing, experts confirmed that the cancer cells of these four patients were indeed from donor organs.

This case is rare in the history of organ transplantation. The reason for this is that experts predict that the donor's genes may have been mutated before the organ donation. The malignant cells enter the bloodstream before the donors are born. However, due to the problem of the donor's own physical constitution, it has not been transferred to a specific lesion, so it was not found in the previous physical examination. After the organ was transplanted into the recipient, the transplant recipient needed to take an immunosuppressive agent to reduce rejection. The reaction also reduces the body's immune function, and the tumor cells cannot be removed by the autoimmune system, so the chance of developing cancer increases.

This case raises a new question in the field of organ transplantation: how to maximize the protection of the recipient's health rights in the future transplantation field?

In this case, cancer cells in the donors could not be detected, and the presence of immunosuppressive agents allowed the cells that might not be carcinogenic to spread and worsen, eventually leading to cancer in transplant recipients.

Can this situation be avoided in the future medical process? Is organ transplantation reliable and safe enough?

Genetic testing of donors may fundamentally reduce the occurrence of similar situations, but the method may be difficult to implement. Because genetic mutations that cause cancer can be divided into two broad categories. One is a germline mutation that is inherited by the patient from the parents. The other is somatic mutation, a genetic mutation that occurs spontaneously in patients due to aging, smoking, and other environmental factors. Hereditary DNA mutations often cause aggressive tumors, including some childhood cancers, but these germline mutations are relatively rare. Most cancers originate from somatic mutations. Genetic testing can only determine the probability of cancer in a patient from a genetic perspective. The price/performance ratio is too low and the implementation is difficult.

The most effective way to deal with "transplantation with cancer" is to perform regular organ screening and timely treatment after transplantation. The only survivor of the four patients in the above case was because of timely examination and the discovery of a large amount of proteinuria in the urine, suspected to be an antibody-induced rejection. After that, the doctor quickly took treatment to eliminate the cancer cells. One year later, the male patient's breast cancer was completely relieved because of early detection and treatment.

This case is an extreme case in the history of organ transplantation. Although regular inspection and timely treatment can not fundamentally avoid such small probability events, it can save the lives of patients to the greatest extent.


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