Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement

Abstract

Patients undergoing evaluation for solid organ transplantation (SOT) often have a history of malignancy. Although the cancer has been treated in these patients, the benefits of transplantation need to be balanced against the risk of tumor recurrence, especially in the setting of immunosuppression. Prior guidelines of when to transplant patients with a prior treated malignancy do not take in to account current staging, disease biology, or advances in cancer treatments. To develop contemporary recommendations, the American Society of Transplantation held a consensus workshop to perform a comprehensive review of current literature regarding cancer therapies, cancer stage‐specific prognosis, the kinetics of cancer recurrence, and the limited data on the effects of immunosuppression on cancer‐specific outcomes. This document contains prognosis based on contemporary treatment and transplant recommendations for breast, colorectal, anal, urological, gynecological, and nonsmall cell lung cancers. This conference and consensus documents aim to provide recommendations to assist in the evaluation of patients for SOT given a history of a pretransplant malignancy.

Selection Criteria for Lung Transplantation: Controversies and New Developments

“…Mainly because the risk of malignancy in transplant recipients is significantly higher compared with the general population, due to an altered immune system as a result of chronic immunosuppression, and the carcinogenic effects of immunosuppressive drugs. [59][60][61][62][63] Posttransplant malignancy rates are depicted in ►Fig. 4.…”

“…62,[64][65][66] Tumor-specific wait periods (e.g., < 2 years for low-grade bladder or prostate cancer and 2 years for thyroid cancer) have been suggested for this increasing pool of candidates, mostly based on data from kidney transplant patients. 59,60,63,67 The patient's risk of death from organ failure must always be weighed against the risk of posttransplant cancer recurrence. 59,60,62,63 As more and more people with prior malignancy undergo lung transplantation, more data on their survival becomes available.…”

“…59,60,63,67 The patient's risk of death from organ failure must always be weighed against the risk of posttransplant cancer recurrence. 59,60,62,63 As more and more people with prior malignancy undergo lung transplantation, more data on their survival becomes available. Patients with pretransplant malignancy have an increased risk of 5-year mortality.…”

Balancing uncertain risks in candidates for solid organ transplantation with a history of malignancy: Who is safe to transplant?

“…In this issue of AJT , Al‐Adra et al present recommendations stemming from an expert consensus conference held to address this issue in 2019 1,2 . The authors review recent advancements in cancer genomics and treatments, and provide a brief summary of the outcomes for cancer patients treated according stage‐specific guidelines.…”

Cancer and transplant: A delicate balance

“…In September 2019, the American Society of Transplantation gathered transplant providers and oncologists for a workshop to establish guidelines to determine when transplant candidates with a history of cancer can undergo transplantation. The results are two consensus expert opinion statements (published in this issue): “Pretransplant solid organ malignancy and organ transplant candidacy” and “Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation.” 1,2 …”