Background: Pre-transplant malignancy (PTM) is considered a relative contraindication for transplantation due to the heightened risk of cancer recurrence associated with immunosuppression. However, little has been explored about other outcomes such as all-cause mortality, cancer mortality, and post-transplant cancer incidence.

Methods: We conducted a population-based retrospective cohort study using transplant and cancer registries linked to administrative data. All Ontario residents undergoing solid organ transplant between 1991 and 2010 were identified in the Canadian Organ Replacement Register and linked to the Ontario Cancer Registry to identify recipients with PTM. Recipients with PTM were matched to recipients without any PTM using a propensity score and overall survival (OS) was compared using the log-rank test and Cox proportional hazards models. For cause-specific mortality, organ/graft failure, and post-transplant cancer incidence, cause-specific hazards models were used and the cumulative incidence of the events was plotted and compared using Gray's test.

Results: A total of 443 recipients with PTM were matched to 886 recipients without PTM. Recipients with PTM had a worse OS compared to recipients without PTM (median OS: 10.3 versus 13.4 years, p<0.001). When stratifying the patients with PTM by the time between cancer diagnosis and transplantation, only the subgroup with intervals ≥5 years were at increased risk of all-cause mortality (HR 1.61 95%CI: 1.32–1.97). Similarly, only recipients with high-risk PTM (those that require minimum cancer remission times of 5 years before listing for transplantation) were at increased risk of all-cause mortality (HR 2.04 95%CI: 1.58–2.64). Recipients with PTM were not only at increased risk of cancer-specific mortality (p<00.1) but also at increased risk of non-cancer death (p=0.02). Similarly, recipients with PTM were at increased risk of organ/graft failure and death with functioning graft (p=0.02 and P=0.01).

Conclusions: Transplant recipients with PTM are at increased risk of all-cause mortality but this is not driven solely by the increased risk of cancer-specific mortality. The increased risk of non-cancer mortality may be associated with increased risk of organ/graft failure.

CITATION INFORMATION: Acuna S, Sutradhar R, Kim J, Baxter N. Outcomes of Solid Organ Transplant Recipients with Pre-Existing Malignancies. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress