Solid organ transplant recipients (SOTR) with a pretransplant malignancy (PTM) are at increased risk for cancer recurrence. However, it is unclear whether differences in survival and incidence of posttransplant de novo malignancies exist between recipients with PTM and those without PTM. We designed a systematic review to synthesize all available evidence assessing these outcomes.
A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies comparing the following outcomes in SOTR by PTM status: (1) all-cause mortality, (2) cancer-specific mortality, and (3) incidence of posttransplant de novo malignancy. Risk of bias was assessed using the Newcastle-Ottawa Scale.
Thirty-two cohort studies were included. Recipients with PTM were at increased risk of all-cause mortality compared to recipients without PTM (pooled hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.27-1.81). Similarly, recipients with PTM were 3 times more likely to die of cancer (pooled HR, 3.13; 95% CI, 2.29-4.27). The pooled HR for developing posttransplant de novo malignancy was also increased (HR, 1.92; 95% CI, 1.52-2.42). The association of all-cause mortality and SOTR with PTM did not vary by transplanted organ.
Pretransplant malignancy is associated with increased risk of all cause-mortality, cancer-specific mortality and of developing de novo malignancies after transplantation compared with those without PTM. These results reaffirm the need for careful selection of transplant recipients with PTM. Tailored screening and management strategies should be developed for this group of patients.
This systematic review demonstrates that a history of a pretransplant malignancy is associated with increased risk of all-cause mortality, cancer-specific mortality and of developing de novo cancer after transplantation, and that such a history should be considered carefully in the pretransplant evaluation process and posttransplant immunosuppression choices. Supplemental digital content is available in the text.
1 Institute of Health Policy, Management and Education, University of Toronto, Toronto, ON, Canada.
2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
3 Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
4 Departments of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
5 Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, ON, Canada.
6 Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Received 9 November 2015. Revision received 20 January 2016.
Accepted 12 February 2016.
This study was funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (Funding Reference No. 115164). The funding sources had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript.
Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the Canadian Institutes of Health Research.
The authors declare no conflicts of interest.
S.A., J.H., C.D., J.K., and N.B. participated in the study conception and design. S.A., J.H., and C.D. participated in data acquisition. S.A., J.H., C.D., P.S., J.K., N.B. participated in data analysis and interpretation. S.A. participated in the first drafting of the article. S.A., J.H., C.D., P.S., J.K., and N.B. participated in the critical appraisal and final approval.
Correspondence: Nancy Baxter, MD, PhD, Division of General Surgery, St. Michael’s Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, Canada M5B 1W8. (BaxterN@smh.ca).
Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).