Introduction: Patients with a history of malignancy prior to kidney transplantation are known to develop more post-transplant malignancies and have inferior outcomes. However, there have been no recent large studies examining trends and outcomes in these patients in the United States. The purpose of this study was to determine the impact of pre-transplant malignancy (PTM) on 1) the development of post-transplant malignancy and 2) patient/graft survival after deceased (DD) and living donor (LD) kidney transplants.

Methods: We queried the Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS) database for all primary kidney transplant recipients from 1994-2016. The development of post-transplant malignancy, patient and graft survival rates in patients with and without PTM were stratified by type of kidney transplant (DD vs LD) and compared using Cox regression and log-rank analyses. Pre and post-transplant malignancy diagnoses included all reported malignant lesions.

Results: Since 1994 both the number and frequency of kidney transplants performed in patients with PTM increased from <1% (n=70) of all kidney transplants in 1994 to 8.5% (n=1341) in 2016. This was true for all PTMs, including non-skin cancer malignancies. Transplant recipients with PTMs were older (60 + 11y) than those without a prior cancer diagnosis (50 + 14y). In comparison to non-PTM recipients, PTM patients had increased frequency of post-transplant malignancy (5% vs 1.7%, p<0.001), lower 10y graft (46.1% vs 54.9%, p<0.001) and 10y patient survival (47.7% vs 59.9%, p<0.001). LD recipients without PTM had the best 10y graft (64.8%) and patient survival (66.5%) while DD recipients with PTM had the worst 10y graft (40.5%, p<0.001) and patient survival (43.3%, p<0.001). Patients with PTM who received a LD kidney had longer 10y graft survival (55.1%) than those receiving a DD (40.5%, p<0.001). LD recipients with PTM had similar 10y patient survival (54.6%) to DD recipients without PTM (55.9%, p>0.05).

Conclusions: Over the last 22 years, more patients with PTM in the United States are receiving kidney transplants. Patients with PTM have inferior graft and patient survival and a higher risk of post-transplant malignancy compared to those without PTM. Additional subgroup analyses will evaluate the influence of organ specific cancer and treatment impact on the survival and graft outcomes in kidney transplant patients.

CITATION INFORMATION: Livingston-Rosanoff D., Wilke L., Leverson G., Foley D. Evaluating the Impact of Pre-Transplant Malignancy on Outcomes after Kidney Transplantation: A National Database Analysis over a Twenty-Two Year Period Am J Transplant. 2017;17 (suppl 3).

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