Introduction: A growing body of evidence indicates that kidney transplant recipients (KTR) with a history of pre-transplant malignancy (PTM)have a higher incidence of post-transplant de-novo malignancies and are at high risk for post-transplant tumor recurrence. However, if a history of PTM affects graft specific outcomes remains unknown.

Methods: We retrospectively analyzed 1217 KTR (2000-2012) for PTM and assessed incidence of post-transplant tumor recurrence as well as post-transplant incidence of de-novo malignancies. In addition, we examined one- and five-year patient and graft survival, incidence of delayed graft function (DGF), acute rejections (AR) and estimated glomerular filtration rate (eGFR). To compare the results, we used two matched control groups similar in age, sex and time under immunosuppressive therapy or similar in age, sex and diagnosis of end-stage renal disease.

Results: We identified 65 KTR patients with a history of PTM; the most common ones being tumors of the urinary system (23%) and skin tumors (23%). The median time from tumor diagnosis to kidney transplantation was 105.55 months (range: 6-468). Of these 65 patients, three (4.6%) experienced tumor recurrence after a median of 34 months. Thirteen (20%) PTM patients developed a second de-novo malignancy, which was comparable to matched controls (n=9, 13.9%, p = 0.143). One- and five-year patient survival was 90.8% and 78.5%, respectively, and similar to matched controls.When comparing graft specific outcomes, we found similar frequencies for DGF, AR and comparable results for one- and five-year eGFR. However, one- and five-year graft survival were significantly decreased in patients with PTM compared to matched controls (nine [13.8%] vs. two [3.1%] deaths, and four [6.2%] vs. 15 deaths [23.1%], p = 0.039 and p =0.003, respectively).

Conclusion: The incidence of tumor recurrence in kidney transplant recipients with a history of PTM was 4.6% and 20% for second de-novo malignancies. Most important, we found a significant decrease in one- and five-year graft survival in PTM patients, independent of post-transplant malignancy. Possible explanations are an extended waiting period for PTM patients, which might increase the burden of co-morbidities or a selection bias when accepting grafts for PTM patients.

CITATION INFORMATION: Becker F., Schütte Nütgen K., Reuter S., Kebschull L., Vowinkel T., Senninger N., Palmes D., Vogel T., Bahde R. Tumor Recurrence in Kidney Transplant Recipients with a History of Pretransplant Malignancy Am J Transplant. 2017;17 (suppl 3).

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