Cancer transmission through corneal transplantation

Quality assurance in corneal transplants: Donor cornea assessment and oversight

The cornea is the most frequently transplanted human tissue, and corneal transplantation represents the most successful allogeneic transplant worldwide. In order to obtain good surgical outcome and visual rehabilitation and to ensure the safety of the recipient, accurate screening of donors and donor tissues is necessary throughout the process. This mitigates the risks of transmission to the recipient, including infectious diseases and environmental contaminants, and ensures high optical and functional quality of the tissues. The process can be divided into 3 stages: (1) donor evaluation and selection before tissue harvest performed by the retrieval team, (2) tissue analysis during the storage phase conducted by the eye bank technicians after the retrieval, and, (3) tissue quality checks undertaken by the surgeons in the operating room before transplantation. Although process improvements over the years have greatly enhanced safety, quality, and outcome of the corneal transplants, a lack of standardization between centers during certain phases of the process still remains, and may impact on the quality and number of transplanted corneas. Here we detail the donor screening process for the retrieval teams, eye bank operators. and ophthalmic surgeons and examine the limitations associated with each of these stages.

[Breast cancer and organ transplantation: Systematic review and meta-analysis]

OBJECTIVES

Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer.

METHODOLOGY

We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data.

RESULTS

In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001).

CONCLUSION

Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.

Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy

Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.

Usability of donor corneas harvested from the deceased having septicaemia or malignancy

CONTEXT

There is a wide gap between supply and demand in relation to healthy corneal grafts. Specific contraindications like infection and malignancy lead to non-usage of many grafts, despite the fact that deeming graft unhealthyness for these two contraindications is debatable.

AIMS

This study was conceptualized to assess if corneas donated from the deceased with septicaemia or malignancy can be deemed fit for implantation.

SETTINGS AND DESIGN

Retrospective histopathological and microbiological analysis of cadaveric donor corneas.

METHODS

A total of 76 donor corneas from 38 patients rejected for corneal transplantation in view of patient having septicaemia or malignancy were analysed for pathological and microbiological workup, to look for dissemination of disease within corneal tissue. Pathology workup included gross and microscopic histopathological evaluation of tissue. Microbiology workup included Grams stain and KOH with calcofluor mount, culture in blood agar, chocolate agar, Sabourauds dextrose agar and Mc Conkeys broth.

RESULTS

A total of 46 donor corneas of 23 septicaemia patients when evaluated showed presence of culture positive infection in 18 patients (78.2%). Histopathological examination done for 30 donor corneas from 15 cancer patients did not reveal presence of tumour cells in the specimen. Corneas of two of cancer patients having septicaemia revealed growth on cultures.

CONCLUSIONS

Corneal tissues harvested from septicaemia donors showed significantly higher incidence of corneal contamination, confirming their unsuitability for usage. However, there was no incidence of tumour transmission in corneal tissues of the patients with malignancies, suggesting that they can be considered for ophthalmic purpose.

How to Deal with the Empty Space After Organ Removal for Transplantation: A Single Medical Center Experience

OBJECTIVE

Dealing with the empty space after organ removal for transplantation has not been investigated.

METHODS

From January 28, 2005, to November 21, 2017, 111 organ donors were enrolled in this study. They were divided into 3 groups: no replacement, replaced with paper printed with organ graphics, or replaced with 3-dimensional (3D) printed simulated organs. The organs were removed at different periods. The donor's age, gender, etiology of admission, characteristics, clinical pictures, time interval between admission and date of donation, and time interval between donor coordinator consultations were evaluated.

RESULTS

A total of 82 men and 29 women with mean age of 43 ± 15.1 years were enrolled. Overall, 329 organs and 126 corneas were transplanted. The major causes of brain death were traumatic brain injury (44.1%) and cerebrovascular disease (32.4%). Twelve donors initially presented with out-of-hospital cardiac arrest. Ten patients with solid cancers and 3 with septic shock donated both of their corneas. The mean time interval between donor coordinator and social worker consultation to organ donation was 3 (2-5 days) (median [interquartile range]). Periods I and II averaged 7-8 donors per year. Fourteen donors and 41 organs were replaced with 3D-printed simulated organs at the families' request in 1 year.

CONCLUSIONS

This is the first study to provide a replacement method dealing with the empty space after organ removal. We used 3D-printed simulated organs in addition to providing grief assistance and spiritual support. It also has the potential effect of increasing the organ donation rate.

Corneal transplantations from donors with cancer

BACKGROUND

Acceptance criteria for corneal donation in some eye banks include cadavers with active cancer, both solid and hematological. Such acceptance is based on the fact that the cornea is an avascular tissue and metastatic dissemination is extremely unlikely.

METHODS

From a total of 588 corneal donors in the Sant Pau Tissue Bank (April 1999 to December 2003), 204 (34.7%) had an active malignancy or a history of malignancy. Of these, 177 had solid cancers and 27 had hematological cancers. Cancer was active in 94.7% and 64% had metastatic dissemination. A histopathological study of the 408 eyes from these 204 donors was performed to rule out metastasis. A total of 325 corneas (79.7%) were transplanted and recipients were followed for an average of 64.1 months (SD 11.1, range 30-86).

RESULTS

The incidence of ocular metastases in the 204 donors with malignancy was 1%, 0.6% for solid cancer, and 3.7% for malignant hematological disease. There was no tumor transmission in any of the 325 recipients.

CONCLUSIONS

The incidence of ocular metastases in corneal donors with active malignancy is very low. Donor-recipient tumor transmission through corneal transplantation is highly improbable when the eyes are free of cancer.

Donor derived malignancy following transplantation: a review

Organ and tissue transplant is now the treatment of choice for many end stage diseases. In the recent years, there has been an increasing demand for organs but not a similar increase in the supply leading to a severe shortage of organs for transplant resulted in increasing wait times for recipients. This has resulted in expanded donor criteria to include older donors and donors with mild disease. In spite of implementation of more stringent criteria for donor selection, there continues to be some risk of donor derived malignancy. Malignancy after transplantation can occur in three different ways: (a) de-novo occurrence, (b) recurrence of malignancy, and (c) donor-related malignancy. Donor related malignancy can be either due to direct transmission of tumor or due to tumor arising in cells of donor origin. We will review donor related malignancies following solid organ transplantation and hematopoeitic progenitor cell transplantation. Further, we will briefly review the methods for detection and management of these donor related malignancies.

Current concepts and techniques in corneal transplantation

The corneal endothelium is the most important single layer in corneal transplantation. In his Castroviejo Lecture, William Bourne, MD, summarizes his work on the corneal endothelium and its importance to corneal transplantation. Almost half the corneal transplants performed in the United States are done so because of malfunctioning, diseased, or absent endothelial cells. If just this layer could be transplanted, the long wait for better vision after keratoplasty (up to two years in some countries) can be eliminated, as well as the problems of epithelial and subepithelial graft rejection. The significant astigmatism after keratoplasty could also be reduced. Transplantation of the endothelium in deep lamellar keratoplasty is being done in limited fashion throughout the world and the first patients have now been done in the United States. In many countries where corneal tissue is difficult to obtain, keratoplasty is only performed on one eye, even though both eyes may need it. One article this year discusses binocular vision recovery in bilateral keratoplasty and the objective and subjective improvements after bilateral keratoplasty. Patients who are bilaterally blind from diseases such as Stevens-Johnson syndrome, and ocular pemphigoid have little hope of visual recovery from conventional corneal transplants. The use of a keratoprosthesis to bypass the totally abnormal conjunctival surface has helped many people in the past. The preoperative prognostic categories of patients who may benefit from keratoprosthesis has been carefully reviewed in a large number of keratoprosthesis patients and this information will help ophthalmologists decide who will benefit the most benefit from keratoprosthesis. This year, articles on corneal transplantation after conjunctival flaps, suture-related complications in keratoplasty, the implantation of an intraocular lens after penetrating keratoplasty, and long-term results of penetrating keratoplasty with glaucoma drainage tube implants are subjects that warrant in depth discussion and evaluation. Finally, eye bank considerations will be discussed concerning the long-term question of transmission of cancer through corneal transplantation.