Incidence and Outcome of Post-Transplant Cancer in Kidney Recipients with or without Pre-Transplant Malignancies

Author(s): Pascal Zimmermann, Dusan Harmacek, Fabian Hauenstein, Andrea Karolin, Anita Hurni, Lucienne Christen, Vanessa Banz, Daniel Sidler

Background: Previously, pre-existing cancers were considered a contraindication for kidney transplantation. Meanwhile, due to improved screening and treatment options, the prevalence of dialysis patients with cancer history is increasing. Potentially these patients could be eligible for kidney transplantation.

Methods: Single center retrospective study, analyzing the incidence and outcome of de novo cancers in kidney transplant recipients with and without pre-existing cancer from 01.01.1981 through 31.12.2018.

Results: The incidence of eligible transplant candidates with pre-existing malignancies increased over the last 40 years, primarily due to diagnosis of limited disease during the pre-transplant evaluations. Outcome is good with comparable graft and patient survival. Incidence of recurrent or secondary de novo cancers is low. The average annual incidence of de novo malignancy is 1 per 100 patient years in the post-transplant follow-up. In the last decades, the incidence of kidney cancers decreased, while lung cancers and post-transplant lymphoproliferative disorder (PTLD) increased. The outcome of malignant disease was poor, notably in patients with disseminated disease at presentation and mainly attributed to cancer-related death. Meanwhile, graft losses were rare after diagnosis of de novo malignancy.

Conclusions: In summary, the incidence of pre-existing and de novo solid cancers increased within the last four decades in our transplant cohort. Patients with pre-existing cancers have an excellent outcome and – if well selected – should not be excluded from transplantation. Meanwhile, de novo cancers after transplantation are associated with poor outcome.

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