KIDNEY TRANSPLANTS IN RECIPIENTS WITH A HISTORY OF CANCER, WE SHOULD DO MORE FOR THEM: A REVIEW OF SRTR DATA

In the United States in 2022 42,887 transplants were done of which 25,498 were kidneys. This was an increase of 3.7% from 2021 and a new annual record.   Of these 14,903 were deceased donors and 6,466 live donors.  Cancer is the second leading cause of death in kidney transplant recipients. In the general population over 1.9 million new cancer cases are expected to be diagnosed in the US in 2022.  This is a hotly debated topic during the evaluation and listing process and many times patients are denied transplant due to our lack of data.  In a recent publication comparing the 1995 to 1999 time to the 2010-2017 time, pretransplant cancer increased from 2% to 5.6%. Published data from the Transplant Center Match Study, a linkage of the SRTR (from 1987 to current) with 33 state and regional cancer registries was used Using N=591,780 US transplants identified (1995-2017) analysis was restricted to first transplant where the recipient lived in a participating cancer registry region (N=419,167). After excluding those with less than 5 year pretransplant, there were N=311,677 patients of which only 11,030 patients were transplanted (3.5% had one pretransplant cancer and 1284 (0.4%) had two or more). This underscores how few patients with a prior diagnosis of cancer are offered a kidney transplant.

SRTR data was requested from all US transplant centers on kidney transplant recipients who had any malignancies prior to the kidney transplant by center and donor type.  The time frame was between 04/05/1989-05/02/2023. 

There are 290 transplant programs that reported data to SRTR, and we selected the top five transplant centers by total volume to see what proportion of patients are transplanted with a history of cancer.  We also report on the top five transplant programs for volume of patients transplanted with an existing prior cancer history.

1.    The programs who performed the most transplants on patients with a prior history of cancer were in states with a historically older population. (Table 1)

2.    The programs with the highest total yearly transplants performed very few total transplants in patients with a prior history of cancer relative even to the total yearly volume. (Table 2)

3.    The University of California San Francisco Medical Center performed more kidney transplants in all recipients in the last two years than it has in recipients with a prior history of cancer in the last 34 years.

4.    Even in the Texas Medical Center (the world’s largest medical center) the three transplant programs have done very few kidney transplants in patients with a prior history of cancer. (Table 3)

Table 1: Top 5 US Transplant Centers by total volume of recipients with pre-transplant diagnosis of cancer transplanted between 04/05/1989-05/02/2023. 

Table 2:  Top 5 Transplants Centers by yearly kidney transplant volume compared to their total volume of transplants with a pre-transplant history of cancer transplanted between 04/05/1989-05/02/2023. 

Table 3: Texas Medical Center Transplant Centers by total volume of recipients with pre-transplant diagnosis of cancer transplanted between 04/05/1989-05/02/2023. 

1.    More kidney transplants are done in the USA than in any other country in the world.  Despite this fact we continue to transplant very few patients with a pre-   transplant diagnosis of cancer.  As the population ages we have more of our potential recipients diagnosed with cancer dying on the UNOS waiting list.

2.    The life expectancy of a transplanted patient even with 2 prior cancers of 51% at 10 years is still better than 17% of those staying on dialysis.

3.    In the USA almost 18 % of deceased donor kidneys are thrown away every year since they are considered poor quality despite the fact that studies show there is no   survival benefit to our patients to turning them down and staying on dialysis.

4.    Transplant centers must develop a thoughtful, data driven pathway for successful transplantation for cancer survivors seeking a transplant.