I have a history of cancer, can I still get a transplant?

Patients on dialysis have an increased risk of cancer compared to the general population but there is no evidence to support more intensive screening of potential transplant recipients above that suggested for the general population.

Cancer is responsible for 9–12% of deaths in renal transplant recipients. Post-transplant immunosuppression likely inhibits surveillance mechanisms that otherwise counteract the development of malignant cell growth. In fact, the risk of a developing new cancers exceeds the risk of recurrence of the original malignancy after transplantation. 

Kidney failure patients that have been successfully treated for their cancer are generally considered to be suitable candidates for  transplantation. Tumor biology varies considerably between cancers and even within the same cancer, therefore a blanket recommendation for malignancy overall would not be valid. The current guidelines are based primarily on registry data from the Israel Penn International Transplant Tumor Registry

More than half of cancer recurrences occurred in patients who had their pre-transplant malignancies treated within 2 years of transplantation. One third of recurrences occurred in patients treated 2–5 years before transplantation and  only 13% of recurrences occurred in patients treated more than 5 years before transplantation

The risk of tumor recurrence has to be balanced against the benefits of renal transplantation for each patient. The following recommendations were formulated with a view to achieve an 80% likelihood of 5 year patient survival. This would be similar to the expected 5 year kidney graft survival.  

No waiting period is recommended after successful treatment for:
  • superficial bladder cancer (in-situ or non-invasive papilloma)
  • in situ cancer of the cervix
  • microscopic prostatic cancer (stage 1)
  • basal cell skin cancer
  • squamous cell skin cancer
  • incidental or T1 renal cell cancers without suspicious histology
  • monoclonal gammopathy of undetermined significance (MGUS).

2 year waiting period is recommended after successful treatment for:
Dr. Israel Penn, founder of IPITTR
  • invasive bladder cancer
  • in situ breast cancer
  • localized cervical cancer
  • stage 1 and 2 colon cancer
  • lymphoma and leukemia
  • lung cancer
  • in situ melanoma
  • prostatic cancer
  • testicular cancer
  • thyroid cancer
  • Wilms tumor
  • localized renal cell cancer

 5 year waiting period  is recommended after successful treatment for:
  • stage 2 breast cancer
  • stage 3 colon cancer
  • melanoma
  • extensive cervical cancer.
  • large invasive renal cell 

The following should not be transplanted:
  • untreated or uncontrolled malignancy
  • multiple myeloma
  • stage 3 breast cancer
  • stage 4 colorectal cancer

These are general guidelines. The care should be individualized and if there is doubt then the Israel Penn International Tumor Registry should be consulted for specific advice.


Popular posts from this blog

Immunosuppression: why and how?

How do I get on the waiting list at the Iowa Methodist Transplant Center?

How do I get a kidney from a deceased donor?