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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Prostate Specific Antigen-Positive Deceased Organ Donor: A Pathologist Is Indispensable.

K Pabisiak1, M Ostrowski2, A Kram3

  • 1Department of Nephrology Transplantation and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.

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|October 16, 2016
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Prostate specific antigen (PSA) levels do not reliably predict prostate cancer in deceased organ donors. Histological evaluation of the prostate is crucial for increasing the organ donor pool while maintaining safety.

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Area of Science:

  • Organ transplantation
  • Urology
  • Pathology

Background:

  • Demographic changes and lack of clear algorithms for prostate specific antigen (PSA)-positive donors may decrease organ recovery.
  • Tumor marker testing in potential donors is now recommended in Poland.
  • Elevated PSA levels (high PSA >10 ng/mL) led to disqualification of 10% of deceased donors in the first year of this recommendation.

Purpose of the Study:

  • To evaluate the utility of histopathological examination of the prostate in deceased organ donors.
  • To determine the correlation between PSA levels and prostate cancer (CaP) or high-grade prostate intraepithelial neoplasia (HGPIN) in donors.
  • To assess the impact of prostate evaluation on the organ donor pool.

Main Methods:

  • A total of 52 male deceased organ donors (median age, 54 years) were included from January 2010 to January 2014.
  • All donors underwent routine histological evaluation of the entire prostate, irrespective of PSA levels.
  • Prostate specific antigen (PSA) levels were recorded and analyzed in relation to histopathological findings.

Main Results:

  • Carcinoma of the prostate (CaP) was detected in 6 donors (12%).
  • No significant correlation was found between PSA levels and the presence of CaP (median 7.0 vs 3.9 ng/mL; P=.51) or HGPIN (median 5.9 vs 4.3 ng/mL; P=.14).
  • All organs (12 kidneys, 3 livers) from donors with CaP were successfully transplanted, increasing the organ donor pool by 15%.

Conclusions:

  • Prostate specific antigen (PSA) values are not associated with the occurrence of prostate cancer in deceased organ donors.
  • Histological verification of the prostate in donors allows for an increased organ pool without compromising safety standards.