Cancer risk following organ transplantation: a nationwide cohort study in Sweden.

A substantial excess risk of lymphomas and nonmelanoma skin cancer has been demonstrated following organ transplantation. Large sample size and long follow-up time may, however, allow more accurate risk estimates and detailed understanding of long-term cancer risk. The objective of the study was to assess the risk of cancer following organ transplantation. A nationwide cohort study comprising 5931 patients who underwent transplantation of kidney, liver or other organs during 1970-1997 in Sweden was conducted. Complete follow-up was accomplished through linkage to nationwide databases. We used comparisons with the entire Swedish population to calculate standardised incidence ratios (SIRs), and Poisson regression for multivariate internal analyses of relative risks (RRs) with 95% confidence intervals (CI). Overall, we observed 692 incident first cancers vs 171 expected (SIR 4.0; 95% CI 3.7-4.4). We confirmed marked excesses of nonmelanoma skin cancer (SIR 56.2; 95% CI 49.8-63.2), lip cancer (SIR 53.3; 95% CI 38.0-72.5) and of non-Hodgkin's lymphoma (NHL) (SIR 6.0; 95% CI 4.4-8.0). Compared with patients who underwent kidney transplantation, those who received other organs were at substantially higher risk of NHL (RR 8.4; 95% CI 4.3-16). Besides, we found, significantly, about 20-fold excess risk of cancer of the vulva and vagina, 10-fold of anal cancer, and five-fold of oral cavity and kidney cancer, as well as two- to four-fold excesses of cancer in the oesophagus, stomach, large bowel, urinary bladder, lung and thyroid gland. In conclusion, organ transplantation entails a persistent, about four-fold increased overall cancer risk. The complex pattern of excess risk at many sites challenges current understanding of oncogenic infections that might become activated by immunologic alterations.

Is there a future for transplantation as we know it today?

If I have to answer the question in the title, the answer will be yes and no. No, there is no future for transplantation, as we know it today. The practices and policies are constantly changing. I hope that in the near future the number of cadaveric donors will increase in most countries owing to improvements in procurement organizations and better medical management of donors. I doubt, however, that it is possible to attain the number of cadaveric donors realized in Spain. Some of us may live to see that the cadaveric donor pool has decreased. Maximized donation without financial incentives for donors or their surviving families will go a long way to meet the demand, but I fear that in the future there will be some financial incentives involved in donation. Yes, there is a future for transplantation and there always will be, but not for transplantation as we know it today The question is whether xenotransplantation or stem cell therapy will be there to take over as the number of allotransplants fail to meet the increasing demand for organ allografts, a demand that cannot be met by a judicious combination of organs from living and deceased donors.

[Anthropometric 3D-body scanning in idiopathic scoliosis]. / Anthropometrische Datenerhebung mittels 3D-Ganzkörperscan bei idiopathischer Skoliose.

PURPOSE: A new, non-invasive method of 3D-measurement is presented which allows the spatial recording of the entire body surface in scoliotic deformities. The application of the system is examined to raise automatically anthropometric data of patients with scoliosis. METHOD: 32 patients with idiopathic scoliosis were examined (average age 15.3 years, 25 girls and 7 boys, Cobb angles between 11 and 72 degrees). The whole body recording is carried out with a 3D laser scanner. During the measuring process the patient is standing in a frame. Within the measuring time of 15 seconds the body surface is registered by lasers and four cameras. The measured values are converted to a digital 3D model. The resolution is up to 1 mm. On the digital 3D model an automatic calculation of defined anthropometric parameters were carried out. Each patient was measured twice. RESULTS: In all patients a virtual 3D model with a high surface accuracy was obtained. Was the model the typical body asymmetries in scoliotic deformities were visible. The automatic calculation shows a mean deviation of the second measurements between 0.23 and 0.71 cm. The reproducibility depended on the type of the measured parameters. CONCLUSIONS: The laser scanning system allows a rapid, touchless and accurate 3D measurement of the whole body in scoliotic deformities. To determine anthropometric parameters the reproducibility of the automatic calculation is sufficient in most parameters.

Incidence of skin cancer in 5356 patients following organ transplantation.

BACKGROUND: Skin cancer following solid organ transplantation is an important cause of morbidity in long-term survivors. This risk is well known but imprecisely quantified. OBJECTIVES: We aimed to determine: (i) the skin cancer risks in transplant patients more precisely; (ii) whether the risk of malignant melanoma is altered; and (iii) whether the risk of epithelial cancers occurring at non-exposed sites is comparable with that seen in sun-exposed sites. METHODS: We linked a population-based cohort of 5356 patients who had received organ transplants in Sweden between 1970 and 1994 with the compulsory Swedish Cancer Registry, to identify all cancer cases except basal cell carcinomas, which are not registered. RESULTS: After a mean follow-up of 5.6 years post-transplantation, 172 of 5356 patients developed 325 non-melanoma skin cancers (excluding basal cell carcinomas) and six malignant melanomas. The relative risk of non-melanoma skin cancer was 108.6 [95% confidence interval (CI) 94.6-123.1] for men and 92.8 (95% CI 73.2-116.0) for women. The highest risks were noted for upper limbs, and the risk increased with time. No significant increase in malignant melanomas was noted: the relative risk was 1.6 (95% CI 0.5-3.7) for men and 0.5 (95% CI 0. 0-2.6) for women. Except for the lip, which is also sun-exposed, other epithelial sites did not show comparable increases in cancer risk. CONCLUSIONS: We conclude that organ transplant recipients are at a highly increased risk for non-melanoma skin cancer and must be closely followed throughout their lives. Cancer risk associated with transplantation is higher for sun-exposed than for non-sun-exposed epithelial tissues, even among populations living in regions with low solar insolation.

Information on new transplant legislation: how it was received by the general public and the action that ensued.

The information campaign was successful. The leaflet was observed by many and discussed by two-thirds of those who had seen it, most often with relatives. All who have registered with the donor register have taken a stand on the donation of organs and tissues for transplantation or other medical purposes. Many more have probably signed donor cards or told the next of kin. It is suggested that the population has been properly informed. The number of cadaver donors, which has decreased the last number of years, seems to be unaffected.

[3-dimensional photogrammetry assessment of facial contours]. / Dreidimensionale photogrammetrische Erfassung von Gesichtsoberflächen.

In Germany, three-dimensional non-invasive measurement techniques are not in routine use for medical purposes. Completely integrated applications of photogrammetric technology are lacking. The results of clinical examination, X-rays and pre- and postoperative photographs from different angles have been used for medical analysis. In an interdisciplinary research project we tested the general applicability of photogrammetric measurement systems. We examined patients with malformations of the mandible-maxilla complex by taking pictures of the face. In order to assess the surface structure we projected regular patterns onto the surface. We calculated about 500 points on the surface with accuracy better than 0.2 mm. Graphical analyses of measurement results are presented in clinically relevant form. We produce representations of the faces in auto-CAD by means of regular meshes which allow views from any perspective, longitudinal and lateral sections. In addition to calculating angles, distances, surfaces and volumes, visualisation of shape is a useful aid in documentation and quantification of changes of soft tissue of the human face under surgery treatment.

The Swedish National Donor Register.

The large number of individuals who have registered with the National donor register indicates that the general public feels there is a need for such a register. It also indicates that the register is accepted by the general public. Considering that the Swedish transplant act is an opting out law, it was to be expected that those objecting to donation would be overrepresented as compared to their representation in the general public. This was confirmed when the opinions of the first 300,000 persons to register were compared to a survey of attitudes made at the same time. According to the guidelines for the medical profession issued by the Board, the Register always has to be consulted in the case of a potential donor. The Register is frequently consulted and found useful by the licensed procurement coordinators. The rulings of the Swedish Data inspection board are to be followed and any divergence will be noted and acted upon by the Board. The new legislation was proposed at a time when the number of cadaver donors was declining. The number of cadaver organ donors remains unchanged. It is concluded that it is for governments to decide on donor registers and for government agencies and professionals to design safe registries and continuously supervise how they are used. The Swedish National Donor Register is safe and operational.

The Swedish National Donor Register.

The large number of individuals who have registered with the National donor register indicates that the general public feels there is a need for such a register. It also indicates that the register is accepted by the general public. Considering that the Swedish transplant act is an opting out law it was to be expected that those objecting to donation would be overrepresented as compared to their representation in the general public. This was confirmed when the opinions of the first 300,000 to register was compared to a survey of attitudes made at the same time. According to the guidelines for the medical profession issued by the Board, the Register always has to be consulted in the case of a potential donor. The Register is frequently consulted and found useful by the licensed procurement coordinators. The rulings of the Swedish Data inspection board are to be followed and any divergence will be noted and acted upon by the Board. The new legislation was proposed at a time when the number of cadaver donors was declining. The number of cadaver organ donors remains unchanged. It is concluded that it is for governments to decide on donor registers and for government agencies and professionals to design safe registries and to continuously supervise how they are used. The Swedish National Donor Register is safe and operational.