A past history of cancer is a relative contraindication to undergoing organ transplantation because of the risk of recurrence of cancer. However, the extent of this risk is not fully established.

To determine the risk of recurrence of cancers after organ transplantation, we used data from the National Transplant Registry to link all organ recipients (1985-2010) in the West Midlands region with the regional Cancer Registry to identify recipients with a history of cancer diagnosed before organ transplantation (excluding liver recipients transplanted with liver cancer) and those who developed a recurrence of cancer following transplantation. The study cohort of 4835 recipients included 3321(69%) kidney, 821(17%) liver, 495(10%) heart and 198(4%) lung recipients. A history of cancer was noted in 64(1.32%) recipients: cancers of breast(8), kidney(8), colon(7), leukaemia(6), lymphoma(6), prostate(4), melanoma(4), bladder(4) and others(18). In total, 5 recipients developed cancer recurrence with a rate of recurrence within 10 years of transplantation of 11.9%(95%CI 0.4,23.5). All five recipients with recurrence had been cancer-free for less than five years pre-transplant. There were no cases of recurrence of cancer in 59 recipients of whom, at transplant, 39 had been cancer-free for more than five years. Melanoma recurred in 3 of the 4 patients with a previous diagnosis; the other 2 cancers which recurred were leiomyosarcoma and testicular cancer. In all 5 cases, the recipients died as a direct consequence of recurrent cancer.

Because of the increasing age of recipients and higher incidence of cancer in patients with renal failure or cirrhosis, more patients with previously treated cancer are considered for transplantation. Our data suggest that a cancer-free period of 5 or more years is associated with very low risk of recurrence of cancer in this selected cohort. Careful risk-benefit assessment should be used prior to offering transplantation to patients who had a cancer within the previous 5 years, particularly in cases with melanoma. As the recurrence of cancer was fatal in every case, informed consent will play an important role in clinical management and also has medico-legal implications.

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