Tumor Recurrence and Graft Survival in Renal Transplant Recipients with a History of Pretransplant Malignancy: A Matched Pair Analysis.

Felix Becker,Stefan Reuter,Andreas Pascher,Katharina Schütte-Nütgen,Vasilios Getsopulos,Anne-Sophie Mehdorn,Jens G Brockmann,Barbara Suwelack,Ralf Bahde

doi:10.3390/jcm10112349

Abstract

Organ scarcity demands critical decision-making regarding eligible transplant candidates and graft allocation to ensure best benefit from renal transplantation (RTx). Among the controversial relative contraindications is a history of pretransplant malignancy (PTM). While oncological outcomes of PTM-RTx recipients are well described, data on graft-specific outcome are scarce. A retrospective double case control matched pair analysis (60 months follow-up) was carried out and RTx-recipients were stratified for history of PTM. First, PTM-RTx recipients were matched according to age, sex and duration of immunosuppressive therapy. Next, PTM-RTx recipients were matched 1:1 for age, sex and cause of end-stage renal disease. Five-year patient and graft survival as well as oncological outcomes were analyzed. A total of 65 PTM-RTx recipients were identified. Post-RTx recurrence rate was 5%, while 20% developed second de novo malignancy, comparable to 14% in the control group. PTM-RTx recipients had a noticeable lower five-year death-censored as well as overall graft survival and Cox proportional hazard modeling showed a correlation between PTM and inferior graft survival. Although underlying reasons remain not fully understood, this study is the first to show inferior graft survival in PTM-RTx recipients and advocates necessity to focus on more meticulous graft monitoring in PTM recipients in addition to heightened surveillance for cancer recurrence.

Highlights

Renal transplantation (RTx) is currently the only definitive therapy for patients with end-stage renal disease (ESRD), providing the possibility to avoid livelong renal replacement therapy (RRT) [1]
Critical risk balancing between RRT and RTx is mandatory to identify suitable transplant candidates
Donor and recipient data were extracted from Eurotransplant Network Information System (ENIS), in-house transplant data files and patient charts [13]

Summary

Introduction

Renal transplantation (RTx) is currently the only definitive therapy for patients with end-stage renal disease (ESRD), providing the possibility to avoid livelong renal replacement therapy (RRT) [1]. Pretransplant malignancy (PTM) has been considered a relative contraindication until a disease-specific minimum remission time has been achieved, varying from two years for early breast, colorectal or renal cancer up to a minimum of five years for more advanced or aggressive entities [5,6,7]. This rather strict strategy is based on the knowledge that PTM is a risk factor for occurrence of post-transplant malignancies since immunosuppressive therapies are known to foster the risk of cancer development and recurrence [5]. Current advances and significant improvements in oncological diagnosis and especially treatment as well as refined immunosuppressive regimes have recently led to updated recommendations concerning

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