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Suggested risk categorizations for specific tumor types*

Suggested risk categorizations for specific tumor types*
Risk category Tumors
No significant risk
  • Benign tumors in which malignancy is excluded
Minimal risk
(<0.1% transmission)
  • Basal cell carcinoma, skin
  • Squamous cell carcinoma, skin without metastases
  • Carcinoma in situ, skin (nonmelanoma)
  • In situ cervical carcinoma
  • In situ vocal cord carcinoma
  • Superficial (noninvasive) papillary carcinoma of bladder (T0N0M0 by TNM stage) (non-kidney transplant only)
  • Solitary papillary thyroid carcinoma, ≤0.5 cm
  • Minimally invasive follicular carcinoma, thyroid, ≤1 cm
  • (Resected) solitary renal cell carcinoma, ≤1 cm, well differentiated (Fuhrman 1 to 2)Δ
Low risk
(0.1 to 1% transmission)
  • (Resected) solitary renal cell carcinoma, >1 and ≤2.5 cm, well differentiated (Fuhrman 1 to 2)Δ
  • Low-grade CNS tumor (WHO grade I or II)
  • Primary CNS mature teratoma
  • Solitary papillary thyroid carcinoma, 0.5 to 2 cm
  • Minimally invasive follicular carcinoma, thyroid, 1 to 2 cm
  • History of treated non-CNS malignancy (≥5 years prior) with >99% probability of cure
Intermediate risk
(1 to 10% transmission)
  • Breast carcinoma (stage 0, ie, carcinoma in situ)
  • Colon carcinoma (stage 0, ie, carcinoma in situ)
  • (Resected) solitary renal cell carcinoma T1b (4 to 7 cm) well differentiated (Fuhrman 1 to 2) stage IΔ[1]
  • History of treated non-CNS malignancy (≥5 years prior) with probability of cure between 90 and 99%
High risk
(>10% transmission)
  • Malignant melanoma
  • Breast carcinoma >stage 0 (active)◊
  • Colon carcinoma >stage 0 (active)◊
  • Choriocarcinoma
  • CNS tumor (any) with ventriculoperitoneal or ventriculoatrial shunt, surgery (other than uncomplicated biopsy), irradiation, or extra-CNS metastasis
  • CNS tumor WHO grade III or IV§
  • Leukemia or lymphoma
  • History of melanoma, leukemia or lymphoma, small cell lung/neuroendocrine carcinoma
  • Any other history of treated non-CNS malignancy either (a) with insufficient follow-up to predict behavior, (b) considered incurable, or (c) with probability of cure <90%
  • Metastatic carcinoma
  • Sarcoma
  • Lung cancer (stages I to IV)[1]
  • Renal cell carcinoma >7 cm or stage II to IV[1]
  • Small cell/neuroendocrine carcinoma, any site of origin
  • Active cancer not listed elsewhere¥
TNM: tumor, node, metastasis; CNS: central nervous system; WHO: World Health Organization.
* Based on level 3 evidence (nonconsecutive cases) unless otherwise specified.
¶ Does not apply to kidney transplant, as lesions may be multicentric.
Δ Assumes complete resection of tumor prior to transplant.
◊ Based on survival data in nontransplant patients.
§ Risk assessment by WHO grade alone may be an oversimplification; evidence suggests that some grade IV tumors, such as uncomplicated glioblastoma, may more appropriately be considered intermediate-risk tumors, whereas others, such as medulloblastoma, are high risk.
¥ Based on collective committee opinion only.
Reference:
  1. AJCC Cancer Staging Manual, 7th ed, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010.
From: Nalesnik MA, Woodle ES, Dimaio JM, et al. Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transplant 2011; 11(6):1140-7. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-6143.2011.03565.x. Copyright © 2011 American Society of Transplantation and the American Society of Transplant Surgeons. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: permissions@wiley.com or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).
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