Kidney Transplantation from Donors with Prostate Cancer
Kidneys from donors with prostate cancer can be safely transplanted, particularly when the donor has low-grade, localized disease, as there has not been a single documented case of prostate cancer transmission through kidney transplantation.
Risk Assessment of Donor Prostate Cancer
Evidence on Transmission Risk
- The risk of prostate cancer transmission through kidney transplantation appears extremely low 1
- No documented cases of prostate cancer transmission during kidney transplantation have been reported in the literature 1
- Estimated incidence of prostate cancer in deceased organ donors is between 3% and 18.5%, with over 100 transplants performed using organs from donors with proven prostate cancer without transmission 1
Risk Stratification by Cancer Type
When evaluating donors with malignancy history, prostate cancer is considered a "low-risk" cancer for transmission, similar to indolent mixed tumors, lip/skin cancers 2
High transmission risk cancers (should be avoided):
- Melanoma
- Lung cancer
- These cancers show <50% recipient survival at 24 months post-transplantation 3
Low transmission risk cancers (may be acceptable):
- Renal cell carcinoma (small, incidental)
- Prostate cancer (especially low-grade, localized)
- These show >70% recipient survival at 24 months post-transplantation 3
Guidelines for Accepting Kidneys from Donors with Prostate Cancer
Donor Evaluation Considerations
Prostate cancer stage and grade:
- Low-grade, localized prostate cancer (especially T1c) presents minimal risk 2
- Advanced or metastatic prostate cancer should be considered a contraindication
Time since treatment:
Recipient factors:
- Consider recipient age and comorbidities
- Balance risk of remaining on dialysis versus minimal risk of cancer transmission
- The overall median survival of patients on hemodialysis in the US is approximately 5 years, and can be less than 1 year in high-risk populations 2
Risk-Benefit Analysis
Benefits of Accepting Kidneys from Donors with Prostate Cancer
- Significantly increases organ availability
- Reduces waiting time for transplantation
- Renal transplantation significantly increases life expectancy compared to remaining on dialysis, even for patients with end-stage renal disease and prostate cancer 4
- The risk of remaining on the waiting list outweighs the minimal transmission risk 1
Risks of Remaining on Dialysis
- Overall median survival on hemodialysis is approximately 5 years 2
- Patients with concomitant heart failure may have less than 1 year survival on dialysis 2
- Quality of life is significantly reduced compared to transplantation
Special Considerations
Immunosuppression and Prostate Cancer
- Little evidence suggests a significant role of immune surveillance in prostate cancer progression 2
- Immunosuppression does not appear to alter the natural history of prostate cancer 2
- No evidence that kidney transplantation and immunosuppression are associated with increased prostate cancer-related risk, neither in incidence nor in aggressiveness 4
Monitoring Post-Transplantation
- Regular PSA monitoring post-transplantation
- Be aware that immunosuppressive agents like sirolimus may decrease PSA levels in male kidney transplant recipients 2
- PSA testing and interpretation are generally no different in transplant patients than in the general population 2
Conclusion
The evidence strongly supports that kidneys from donors with low-grade, localized prostate cancer can be safely used for transplantation. The risk of transmission is minimal to non-existent, while the benefits of transplantation versus remaining on dialysis are substantial. This approach helps expand the donor pool and provides life-saving transplants to patients who might otherwise remain on dialysis with significantly reduced life expectancy and quality of life.