In most western countries, the median donor age is increasing. The incidence of malignancies in older populations is increasing as well. To prevent donor-derived malignancies we evaluated radiologic donor screening in a retrospective donor cohort.
This study analyzes the efficacy of a preoperative computed tomography (CT) scan on detecting malignancies. All deceased organ donors in the Netherlands between January 2013 and December 2017 were included. Donor reports were analyzed to identify malignancies detected before or during organ procurement. Findings between donor screening with or without CT-scan were compared.
Chest or abdominal CT-scans were performed in 17% and 18% of the 1644 reported donors respectively. Screening by chest CT-scan versus radiograph resulted in 1.5% and 0.0% detected thoracic malignancies respectively. During procurement no thoracic malignancies were found in patients screened by chest CT compared with 0.2% malignancies in the radiograph group. Screening by abdominal CT-scan resulted in 0.0% malignancies, compared with 0.2% in the abdominal ultrasound group. During procurement 1.0% and 1.3% malignancies were found in the abdominal CT-scan and ultrasound groups, respectively.
Screening by CT-scan decreased the perioperative detection of tumors by 30%. A preoperative CT-scan may be helpful by providing additional information on (aberrant) anatomy to the procuring or transplanting surgeon. In conclusion, donor screening by CT-scan could decrease the risk of donor-derived malignancies and prevents unnecessary procurements per year in the Netherlands.
1 Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
2 Department of Organ and Tissue Donation, Dutch Transplant Foundation, Leiden, The Netherlands.
3 Department of Surgery, Division of Transplantation, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
4 Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
5 Department of Surgery, Division of Transplantation, Erasmus Medical Center, Rotterdam University, Rotterdam, The Netherlands.
6 Department of Surgery, Division of Vascular and Transplant Surgery, University Medical Center St. Radboud, Nijmegen University, Nijmegen, The Netherlands.
7 Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
8 Department of Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands.
9 Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands.
Published online 15 November, 2019.
Received 5 September 2019.
Accepted 29 September 2019.
The authors declare no funding or conflicts of interest.
A.E.B., I.P.J.A., and J.W.M. participated in research design. J.W.M. participated in data collection. A.E.B., R.A.P., and J.W.M. participated in data analysis. All authors participated in construction and critical revision of the article.
Correspondence: J.W. Mensink, MD, Department of Surgery, Division of Transplantation, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. (firstname.lastname@example.org).
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