Malignancy prevalence in dialyzed patients evaluated for kidney transplantation and actively waitlisted

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Malignancy prevalence in dialyzed patients evaluated for kidney transplantation and actively waitlisted

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Co-author 1

Slawomir Malyszko smalyszko1999@gmail.com Medical University of Warsaw Physiology Warsaw Poland *

Co-author 2

Letycja Rog letycja.rog96@gmail.com Medical University of Warsaw Oncology Warsaw Poland -

Co-author 3

Jacek Malyszko jackmaly@poczta.onet.pl Medical University of Bialystok Nephrology, Transplantation and Internal Medicine Bialystok Poland -

Co-author 4

Ewa Wojtaszek wojtaszek.ewa@gmail.com Medical University of Warsaw Nephrology, Dialysis and Internal Medicine Warsaw Poland -

Co-author 5

Pawel Zebrowski zebpaw@wp.pl Medical University of Warsaw Nephrology, Dialysis and Internal Medicine Warsaw Poland -

Co-author 6

Jolanta Malyszko jolmal@poczta.onet.pl Medical University of Warsaw Nephrology, Dialysis and Internal Medicine Warsaw Poland -

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Introduction

The overall incidence of malignancy in patients with end-stage kidney disease (ESKD) is reportedly higher compared to the general population. Cancer remains one of the dominant causes of death in these patients, due in part to uremia-induced impairment of tumor immune surveillance. Kidney transplantation is the optimal therapy for end-stage kidney failure. As patients with kidney disease often have significant comorbidities, the evaluation of a potential kidney transplant recipient should be as efficient and cost-effective as possible. Even successful kidney transplantation bears some serious complication including malignancy. On the other hand, malignancy is one of the major limitations in the evaluation of potential kidney transplantation.The aim of this study was to assess the prevalence of malignancy in dialyzed patients in the relation to the waiting list.

Methods

The cross-sectional study was conducted in 123 prevalent patients in the regional qualification center, with 24 patients being actively waitlisted, 73 during evaluation and 28 being temporarily disqualified. We assessed demographic data, basal biochemical data, and comorbidities, including malignancy, in relation to age, sex, presence of metastasis, and being actively waitlisted.

Additionally, we assessed prevalence of malignancy in dialysis unit among PD (n=18) and HD (n=92) patients, including 13 actively waitlisted.

Results

Patients who had been active on the cadaver kidney waiting list and not listed did not differ in regard to sex, dialysis vintage, and causes of end-stage renal failure, but were significantly younger. In regional qualification center, among actively waitlisted 4 had a history of malignancy. Among patients during evaluation, 7 had a history of cancer. Temporary disqualification was due to either exacerbated cardiovascular disease or acute illness. Active malignancy was the reason of temporal withholding from the waiting list in only 2 cases.

In dialysis unit in waitlisted patients only 2 had a history of malignancy. Among hemodialysis patients, 10 of them had a history of malignancy and 2 in the peritoneal dialysis population.

Conclusion

Concluding, waitlisted patients represent a very selected and healthier dialyzed population. After COVID-19 pandemic prevalence of malignancy (10%) appears to be lower than prepandemic. Cancer screening in potential transplant recipients is of paramount importance as immunosuppression may increase risk of malignancy

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