Impact of pre-transplant malignancy on outcomes in kidney transplant recipients: an updated meta-analysis with systematic review

Abstract

Purpose: Kidney transplantation is the optimal therapy for end-stage renal disease, but pre-transplant malignancy (PTM) is a concern due to the increased risk of cancer recurrence with immunosuppression. While advancements in immunosuppression and cancer treatments have improved kidney recipient and graft survival, the impact of PTM on survival remains unclear and warrants comprehensive assessment.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. Relevant studies were identified through searches in PubMed, EMBASE, and Cochrane Library from inception to 1st May 2024 for outcomes including all-cause mortality, cancer-specific mortality, graft survival, death-censored graft survival, and de novo malignancy.

Results: Eighteen studies were included in meta-analyses for various outcomes. Kidney transplant recipients with PTM had significantly higher all-cause mortality {hazard ratio [HR] = 1.45 [95% confidence interval (CI) 1.19-1.78]}, cancer-specific mortality [HR = 2.66 (95% CI 1.50-4.72)], risk of post-transplant de novo malignancy [HR = 1.66 (95% CI 1.22-2.25)] and worse graft survival [HR = 1.13 (95% CI 1.05-1.21)] compared to those without PTM. However, there was no significant difference in death-censored graft survival [HR = 1.09 (95% CI 0.82-1.45)].

Conclusions: Kidney transplant recipients with PTM experienced an increased risk of all-cause mortality, cancer-specific mortality, graft loss, and post-transplant de novo malignancy compared to those without PTM. Careful assessment, focused screening, and tailored management protocols are necessary for this high-risk group of patients.

Keywords: Graft survival; Kidney transplantation; Meta-analysis; Mortality; Pre-transplant malignancy.