title: Association Between Pretransplant Cancer and Survival in Kidney Transplant Recipients.
abstract: Kidney transplantation in recipients with a previous malignancy is often deferred 2 to 5 years after cancer treatment due to fear of cancer recurrence. In Norway, the required waiting period has been 1 year.
  
  
  
  We compared patient and graft survival of recipients with pretransplant cancer to the outcomes of matched recipients without such cancer (comparators) using Cox regression.
  
  
  
  From 1963 to 2010, 377 (6.4%) of 5867 recipients had a pretransplant cancer. During a median follow-up of 6.8 years, 256 recipients died, 35 (13.7%) from recurrent cancer and 27 (10.5%) from de novo cancer. Uncensored and death-censored graft loss occurred in 263 and 46 recipients, respectively. All-cause mortality was similar as in comparators (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.93-1.20]; P = 0.40), death-censored graft loss was lower (HR, 0.63; 95% CI, 0.47-0.84; P = 0.002), and uncensored graft loss was similar (HR, 0.99; 95% CI, 0.87-1.12; P = 0.87). Cancer mortality was higher than in comparators (HR, 1.97; 95% CI, 1.51-2.56; P < 0.001), particularly during the first 5 years of follow-up (HR, 3.44; 95% CI, 2.36-5.03; P < 0.01). Waiting period was not associated with recurrent cancer mortality or all-cause mortality (both P > 0.45). Results were similar within cancer subgroups, with most data in patients with a history of kidney cancer, prostate cancer, urothelial cancer, and skin squamous cell carcinoma.
  
  
  
  Kidney transplant recipients with a pretransplant cancer had a similar overall patient and graft survival as recipients without such cancer. Cancer mortality was increased, particularly during the first 5 years after transplantation. A short waiting period was not associated with mortality.
authors.affiliation: 1 Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway. 2 The Cancer Registry of Norway, Oslo, Norway. 3 Norwegian Renal Registry, Oslo University Hospital, Oslo, Norway. 4 Department of Internal Medicine, Ringerike Hospital, Vestre Viken Hospital Trust, Norway.
authors.forename: Dag Olav
authors.initials: DO
authors.lastname: Dahle
authors.forename: Tom
authors.initials: T
authors.lastname: Grotmol
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
authors.forename: Karsten
authors.initials: K
authors.lastname: Midtvedt
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisæter
authors.forename: Geir
authors.initials: G
authors.lastname: Mjøen
authors.forename: Hege K
authors.initials: HK
authors.lastname: Pihlstrøm
authors.forename: Hege
authors.initials: H
authors.lastname: Næss
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D066027:Transplant Recipients