*Purpose: The population of the United States is aging. By the year 2050 those over 65 years of age are projected to make up 20.2% of the total population. Renal transplantation in those with previous prostate malignancy is becoming more prevalent in this changing demographic landscape. However historically, malignancy was considered a contraindication for renal transplantation. Current guidelines recommend that prostate malignancy be treated and followed by a surveillance period ranging from 2 to 5 years. However, the decision to transplant in this patient population is both surgeon- and institution- dependent, resulting in variations in management. This study aims to analyze overall survival and graft survival of renal transplantation between patients with previous prostate malignancy (PPM) versus no prior prostate malignancy (NPPM) and offer clearer guidance to surgeons deciding transplant or no transplant.

*Methods: This study used kidney transplant data from the United Network for Organ Sharing (UNOS) database which included transplant data from October 1, 1987 through December 31, 2020. 1156 renal transplant recipients with previous prostate malignancy (“PPM group”) were isolated and case control matched by recipient age, sex, and ethnicity to renal transplant recipients who were recorded as having no previous prostate malignancy (“NPPM group”). Statistical analysis 129 Propensity score matching (PSM) was applied to reduce selection bias between the 130 study groups. Demographic data were compared between groups using Fisher’s exact test or the chi-square test, as appropriate. Continuous variables are expressed as the median ± inter- 140 quartile range (IQR)

*Results: There was a significant difference in graft lifespan between the PPM group and the NPPM group, respectively (44.2 vs. 65.1 months; P<0.001). There was also a significant difference in median patient survival time between the two groups with the NPPM group surviving longer (76.7 vs. 47.3 months; P<0.001). The percentage of patients who received dialysis within the first week of their kidney transplant used as a surrogate for delayed graft function was evenly matched between the PPM group and the NPPM group (24.5% vs. 25.1%; P=0.736). The NPPM group had a higher percentage of patients treated for rejection both at 1 year and at 6 months, respectively (6.8% vs. 4%; p=0.01; 6.6% vs. 3.7%; P=0.006). A higher percentage of the NPPM group died with a functioning graft (47.6% vs. 20.9%; P<0.001).

*Conclusions: Graft lifespan as well as patient overall survival were longer for renal transplant recipients without previous malignancy. However, renal transplants recipients with previous prostate malignancy had lower rates of delayed graft function and treatment for rejection at 6 months and 1 year. These results offer some food for thought for clinicians transplanting patients with prior prostate malignancy. Further study is warranted to assess the variation in transplant outcomes among these two groups.

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