Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink?

Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink?

Publication date: Dec 01, 2019

Kidney transplant recipients have up to a 100-fold greater risk of incident cancer compared with the age/sex-matched general population, attributed largely to chronic immunosuppression. In patients with a prior history of treated cancers, the type, stage and the potential for cancer recurrence post-transplant of prior cancers are important factors when determining transplant suitability. Consequently, one of the predicaments facing transplant clinicians is to determine whether patients with prior cancers are eligible for transplantation, balancing between the accelerated risk of death on dialysis, the projected survival benefit and quality of life gains with transplantation, and the premature mortality associated with the potential risk of cancer recurrence post-transplant. The guidelines informing transplant eligibility or screening and preventive strategies against cancer recurrence for patients with prior cancers are inconsistent, underpinned by uncertain evidence on the estimates of the incidence of cancer recurrence and the lack of stage-specific outcomes data, particularly among those with multiple myeloma or immune-driven malignancies such as melanomas. With the advent of newer anti-cancer treatment options, it is unclear whether the current guidelines for those with prior cancers remain appropriate. This review will summarize the uncertainties of evidence informing the current recommendations regarding transplant eligibility of patients with prior cancers.

Lim, W.H., Au, E., Krishnan, A., and Wong, G. Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink? 24974. 2019 Transpl Int (32):12.

Concepts Keywords
Cancer Cancer treatment
Dialysis Cancers
Immunosuppression Malignancies melanomas
Incidence Prior cancers
Kidney Transplant Newer anti cancer
Malignancies Immunosuppression
Melanomas Dialysis
Mortality Kidney transplant
Multiple Myeloma Medicine
Medical specialties
Clinical medicine
Organ transplantation
Kidney transplantation
Immunology
Multiple myeloma
Immunosuppression
Transplantation medicine
Transplantation
Dialysis

Semantics

Type Source Name
disease MESH cancers
disease MESH recurrence
disease MESH death
disease MESH premature mortality
disease MESH multiple myeloma
disease MESH melanomas
pathway KEGG Melanoma

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