Evaluating the waiting policy in patients with malignancies prior to renal transplantation: acceptable risks of recurrence after trans­plantation

J. van de Wetering, J. Kal-van Gestel, C. Konijn, T. Luth, W. Weimar, A.J. Hoitsma, M.G.H. Betjes

Chair(s): dr. Marije C. Baas, nefroloog, Radboudumc, Nijmegen & dr. Dries E. Braat, chirurg, LUMC

Thursday 10 march 2016

14:50 - 15:00h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie XII - Klinisch

Introduction:
A history of malignancy is considered a relative contraindication for transplantation and a tumor-free period of 3-5 years is usually advised before patients are considered eligible for transplantation. However, little is known about the risk of recurrence of malignancies after transplantation using this policy. The Dutch Organ Transplant Registry (NOTR) database only registers malignancies after transplantation. We investigated whether linking the national cancer database with the NOTR can provide us with adequate information needed to make a statement about this risk.

Methods:
The NOTR is operational since 2001 and includes the clinical data from recipients with a functioning organ transplant as reported yearly by the transplant centres. From 1989 onwards, the IKNL (Integraal Kanker Centrum Nederland) collects nationwide pathology results documenting malignancy in a database. All renal transplant recipients (RTR), transplanted between 1966 and 2013, were connected with the IKNL database using surname, sex, date of birth, ZIP code and treatment hospital. Data reporting malignancies of both databases were compared.

Results:
The NOTR contained 16717 RTR of which 3690 (22%) were diagnosed with a non-melanoma skin(NMS) and/or a solid tumor in the IKNL database. 593 (16%) RTR had a tumor before transplantation (RT);85 patients had only NMS tumor(s),508 had at least one solid tumor before RT. Of this 508 patients with at least one solid tumor before RT the median time before transplantation of the first tumor was 6 years (range 1-32 yrs). 53 RTR had more than one (max 5) solid tumor before transplantation. Only 21 (4%) of the 508 patients had a recurrence of their solid tumor at a median time of 3 (range 0-13) yrs after RT, 8,5 (range 3-24) yrs after the original tumor. The median tumor-free time before RT in RTR with recurrence was 5 (1-17) yrs. The primary tumors and recurrence rate were: 4 out of 69 bladder, 1 out of 44 colon, 5 out of 127 kidney, 1 out of 18 lung, 1 out of 15 non-Hodgkin lymphoma, 8 out of 66 breast and 1 out of 53 prostate tumors showed a recurrence after RT. There was no significant difference in tumor-free period before RT in RTR with or without recurrence.

Conclusion:
The current policy of using a tumor-free before transplantation leads to an acceptable recurrence rate of malignancy after RT, which is in general below 5% and ranges between 1.8% and 12.2 %.