MON-185 MALIGNANCY PREVALENCE IS LOWER IN WAITLISTED POTENTIAL KIDNEY TRANSPLANT RECIPIENTS COMPARED TO KIDNEY TRANSPLANT RECIPIENTS

Abstract

The optimal renal replacement therapy is kidney transplantation because it improves quality of life, prolongs survival, and is cost-effective. Malignancy became the second leading cause of death in kidney allograft recipients. The aim of this study was to the prevalence of malignancy in patients with end-stage renal disease on the kidney transplantation waiting list and in kidney allograft recipients. The cross-sectional study was conducted in 50 prevalent patients on the waiting list and 315 kidney allograft recipients in one single evaluation center and ambulatory transplantation unit covering population of about 1 mln people (9 HD units and PD unit refer potential kidney transplant recipients). Patients who had been registered in the cadaver kidney waiting list and kidney allograft recipients did not differ in regard to age, sex, dialysis vintage and causes of end-stage renal failure. In waitlisted patients only 3 had a history of malignancy (renal cell carcinoma, tongue carcinoma, gastric cancer) which account for the 3% of the population. In kidney allograft recipients, in 58 patients malignancy developed which accounts for 18% of the population studied. The leading malignancy was skin cancer- 10 cases, followed by PTLD (post-transplant lymphoproliferative disorder) in 5 cases, Kaposi sarcoma- cases, brain cancer- 2 cases, Merkel carcinoma in 2 cases, lung cancer (small cell and non-small cell), unknown origin – 2 cases and other 27 malignancies were in single patient (including one leukemia and one multiple myeloma). 18 deaths were recorded in kidney allograft recipients with malignancy mainly in PTLD, Kaposi sarcoma, Merkel carcinoma, sarcoma and brain cancer. Skin cancer has the best outcome. Concluding, waitlisted patients represent a very selected and healthier dialyzed population. As dialyzed population is getting older, we might consider to expand the possibility for older and sicker population to benefit from kidney transplantation, however, the shortage of organs makes it very difficult to implement.As prevalence of malignancy is increasing in kidney allograft recipients, screening in this population is of utmost importance. Guidelines for cancer screening in both potential transplant recipients and kidney allograft recipient should be developed as nowadays there are scarcity of data in this matter. Minimization of immunosuppressive regimen should be considered, in particular, in high risk patients.