Association Between Pretransplant Cancer and Survival in Kidney Transplant Recipients.

Background: Kidney transplantation in recipients with a previous malignancy is often deferred 2-5 years after cancer treatment due to fear of cancer recurrence. In Norway, the required waiting period has been 1 year. Methods: We compared patient and graft survival of recipients with pretransplant cancer to the outcomes of matched recipients without such cancer (comparators) using Cox regression. Results: From 1963 to 2010, 377 of 5867 recipients (6.4%) had a pretransplant cancer. During a median follow-up of 6.8 years, 256 recipients died, 35 (13.7%) from recurrent cancer and 27 (10.5%) from de novo cancer. Uncensored and death-censored graft loss occurred in 263 and 46 recipients, respectively. All-cause mortality was similar as in comparators (HR 1.06 [0.93-1.20], P=0.40), death-censored graft loss was lower (HR 0.63 [0.47-0.84], P=0.002), and uncensored graft loss was similar (HR 0.99 [0.87-1.12], P=0.87). Cancer mortality was higher than in comparators (hazard ratio [HR] 1.97 [95% confidence interval 1.51-2.56], P0.45). Results were similar within cancer subgroups, with most data in patients with a history of kidney cancer, prostate cancer, urothelial cancer and skin squamous cell carcinoma. Conclusion: Kidney transplant recipients with a pretransplant cancer had a similar overall patient and graft survival as recipients without such cancer. Cancer mortality was increased, particularly during the first 5 years after transplantation. A short waiting period was not associated with mortality. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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