Evaluation of transplant candidates with pre-existing malignancies.
(1)Department of Surgery, University of Cincinnati Medical Center, USA.
A retrospective study was done of the recurrence rates of 1297 preexisting tumors
in renal transplant recipients. Of 1137 neoplasms that were treated prior to
transplantation, the recurrence rate was 21%, and it was 33% in 99 cancers
treated after transplantation. Fifty-four percent of recurrences in the
pretransplant-treated group occurred among malignancies treated within 2 years of
transplantation, 33% in those treated 2-5 years before transplantation, and 13%
among those treated more than 5 years pretransplantation. Among the 31 neoplasms
in the last group 52% of recurrences occurred within 2 years after
transplantation. Among those cancers treated pretransplantation the highest
recurrence rates occurred with breast carcinomas (23%), symptomatic renal
carcinomas (27%), sarcomas (29%), bladder carcinomas (29%), nonmelanoma skin
cancers (53%) and multiple myeloma (67%). In the tumors treated
posttransplantation 39% of recurrences were from nonmelanoma skin cancers. The
bulk of evidence suggests that immunosuppressive therapy facilitates the growth
of residual cancers. With some exceptions a minimum waiting period of 2 years
between treatment of a neoplasm, with a favorable prognosis, and undertaking
renal transplantation is desirable. A waiting period of approximately 5 years is
desirable for lymphomas, most carcinomas of the breast, prostate or colon, or for
large (> 5 cm) symptomatic renal carcinomas. No waiting period is necessary for
incidentally discovered renal carcinomas, in situ carcinomas, and possibly tiny
focal neoplasms. As it is highly unlikely that most candidates for nonrenal
transplantation can be kept alive for a two year waiting period nonrenal
transplantation can be undertaken in patients who have been treated for major
cancers, provided that the disease appears to have been adequately controlled,
and that the stage of the malignancy does not have a poor prognosis.
PMID: 9869873 [PubMed - indexed for MEDLINE]
Overall and cause-specific mortality in transplant recipients with a pretransplantation cancer history.
Brattström C(1), Granath F, Edgren G, Smedby KE, Wilczek HE.
(1)Division of Transplantation Surgery, Department of Clinical Science,
Intervention and Technology, Karolinska Institutet, Karolinska University
Hospital, Stockholm, Sweden.
BACKGROUND: It is unclear to what extent cancer history affects
posttransplantation mortality in solid organ transplant recipients.
METHODS: We identified a Swedish population-based cohort of solid organ
transplant recipients in the National Patient Register 1970 to 2008 and linked it
to the Cancer and Cause-of-Death Register. Overall and cause-specific mortality
was estimated using Cox regression.
RESULTS: Of 10,448 eligible recipients, 416 (4%) had a prior malignancy unrelated
to the indication for transplantation diagnosed 2 months or more before surgery
(median, 5.7 years). Mortality among cancer history recipients was 30% increased
after transplantation, compared with other recipients (adjusted hazard ratio
[HR], 1.3; 95% confidence interval [CI], 1.1-1.5; P<0 .001="" br="" by="" driven="">cancer-specific death with no increase in cardiovascular, infectious, or other
noncancer mortality. An increased rate of death due to cancer history was
primarily observed among nonkidney recipients (adjusted HR(nonkidney), 1.8; 95%
CI, 1.3-2.5; HR(kidney), 1.2; 95% CI, 1.0-1.4). Rates were greatest for patients
with waiting times of 5 years or less but persisted with waiting times more than
10 years among kidney and nonkidney recipients with prior aggressive cancer types
(gastrointestinal, breast, kidney/urothelial, and hematologic malignancies).
CONCLUSION: We conclude that organ transplant recipients with cancer history are
at a moderately increased rate of death after transplantation, driven primarily
by death due to cancer recurrence.
PMID: 23759880 [PubMed - indexed for MEDLINE]