Outcomes of Solid Organ Transplant Recipients With Preexisting Malignancies in Remission: A Systematic Review and Meta-Analysis.
BACKGROUND
Solid organ transplant recipients (SOTR) with a pretransplant malignancy (PTM) are at increased risk for cancer recurrence. However, it is unclear whether differences in survival and incidence of posttransplant de novo malignancies exist between recipients with PTM and those without PTM. We designed a systematic review to synthesize all available evidence assessing these outcomes.


METHODS
A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies comparing the following outcomes in SOTR by PTM status: (1) all-cause mortality, (2) cancer-specific mortality, and (3) incidence of posttransplant de novo malignancy. Risk of bias was assessed using the Newcastle-Ottawa Scale.


RESULTS
Thirty-two cohort studies were included. Recipients with PTM were at increased risk of all-cause mortality compared to recipients without PTM (pooled hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.27-1.81). Similarly, recipients with PTM were 3 times more likely to die of cancer (pooled HR, 3.13; 95% CI, 2.29-4.27). The pooled HR for developing posttransplant de novo malignancy was also increased (HR, 1.92; 95% CI, 1.52-2.42). The association of all-cause mortality and SOTR with PTM did not vary by transplanted organ.


CONCLUSIONS
Pretransplant malignancy is associated with increased risk of all cause-mortality, cancer-specific mortality and of developing de novo malignancies after transplantation compared with those without PTM. These results reaffirm the need for careful selection of transplant recipients with PTM. Tailored screening and management strategies should be developed for this group of patients.
1 Institute of Health Policy, Management and Education, University of Toronto, Toronto, ON, Canada. 2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 3 Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada. 4 Departments of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada. 5 Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, ON, Canada. 6 Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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D000328:Adult; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome