Whole Body CT Imaging in Post-Mortem Donor Screening

J.W. Mensink, R.A. Pol, W.N. Nijboer, J. de Jonge, K.M. Ooms - de Vries, M. van der Jagt, M.C.G. van de Poll, I.P.J. Alwayn, A.E. Braat

Thursday 14 march 2019

13:31 - 13:33h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

Background: To increase the number of suitable organs for transplantation, it is current practice to include extended criteria donors. By extending age criteria, not only organ quality decreases but the risk of malignancy increases. Our aim was to analyze the effect of a preoperative computed tomography (CT) scan on identifying malignancies and to perform a systematic literature search on radiologic screening of potential post-mortem donors.

Methods: We included all patients reported as post-mortem organ donor in the Netherlands between January 1st, 2013 and December 31st, 2016. Donor reports were analyzed to identify results of radiologic investigations or (suspected) malignancies found during MOD procedures. We compared findings between the conventional donor screening protocol and donor screening including a CT-scan. Studies were excluded for our systematic review if they were not describing post-mortem donor screening by imaging or if they were not available in English.

Results: Chest or abdominal CT-scans were performed in 17% and 18% of the 1375 reported donors respectively. Screening by chest CT-scan versus chest X-ray resulted in 1.3% and 0.2% thoracic malignancies found respectively. During MOD procedures no thoracic malignancies were found in patients screened by chest CT compared to 0.2% malignancies in the chest X-ray group. Screening by abdominal CT-scan resulted in 0.4% malignancies, compared to 0.1% in the abdominal ultrasound (US) group. During MOD procedures, 0.8% and 1.6% malignancies were found in the abdominal CT-scan and US groups respectively. Based on selection criteria 3 articles were further analyzed. Two prospective cohort studies evaluated CT-scanning in post-mortem donor screening. The studies reported in 8% and 11% of the cases a (possible) malignancy and in 4% and 11% of the cases the MOD procedure was cancelled because of an active malignancy. The third study evaluated diagnostic imaging of potential lung donors and its clinical relevance. In 7% of the patients a (possible) malignancy was reported.

Conclusions: CT-scanning decreased the percentages of perioperative detection of tumors, from 0.2% to 0% for thoracic imaging and from 1.6% to 0.8% for abdominal imaging. Another possible advantage of extended screening is to enhance the pre-operative planning by providing additional information on (aberrant) anatomy. In conclusion, it could decrease the risk of donor derived malignancies and prevent about 2-3 unnecessary MOD procedures per year in the Netherlands.