Cited by 163Transplantation: Methods and OutcomesOrgan and Tissue Transplantation ResearchViral-associated cancers and disorders

Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement

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Al-Adra, David P., Hammel, Laura, Roberts, John, Woodle, E. Steve, Levine, Deborah, Mandelbrot, Didier, Verna, Elizabeth, Locke, Jayme +27 more·2021·American Journal of Transplantation

Abstract

Patients undergoing evaluation for solid organ transplantation (SOT) often have a history of malignancy. Although the cancer has been treated in these patients, the benefits of transplantation need to be balanced against the risk of tumor recurrence, especially in the setting of immunosuppression. Prior guidelines of when to transplant patients with a prior treated malignancy do not take in to account current staging, disease biology, or advances in cancer treatments. To develop contemporary recommendations, the American Society of Transplantation held a consensus workshop to perform a comprehensive review of current literature regarding cancer therapies, cancer stage-specific prognosis, the kinetics of cancer recurrence, and the limited data on the effects of immunosuppression on cancer-specific outcomes. This document contains prognosis based on contemporary treatment and transplant recommendations for breast, colorectal, anal, urological, gynecological, and nonsmall cell lung cancers. This conference and consensus documents aim to provide recommendations to assist in the evaluation of patients for SOT given a history of a pretransplant malignancy.

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  • Transplantation may be considered in patients with carcinoma not significantly affected by immunosuppressants.

    “in patients with carcinoma not significantly affected by immunosuppressants”

    From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [6]

    The Breast Cancer and Gynecologic Cancers transplant-recommendation sections (pages unavailable) say that selected patients with low-risk, treated cancers may be considered for transplantation. The Introduction does not establish that their carcinomas are unaffected by immunosuppression; it identifies increased recurrence risk as a concern and says evidence on safety in patients with pretransplant malignancy is limited. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Transplantation may be considered in patients with a previous cancer history who are well-maintained and without recurrence for more than 5 years.

    “transplantation may be considered in patients with a previous cancer history who are well-maintained and without recurrence for more than 5 years”

    From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [6]

    The Colorectal Cancer and Gynecologic Cancers transplant-recommendation sections say that some patients with treated cancer and no recurrence may be considered for transplantation, including after disease-free intervals of 3–5 years. The paper does not give more than five years without recurrence as a general criterion for all previous cancers: recommendations vary by cancer and risk, and the Breast Cancer recommendations say some patients generally should not be candidates. Page numbers are unavailable in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Transplantation should be avoided if a metastatic lesion is present, there is a high risk of recurrence, or the patient's life expectancy is short.

    “transplantation should be avoided if a metastatic lesion is present, there is a high risk of recurrence, or the patient’s life expectancy is short [6,7].”

    From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [6]

    The Breast Cancer transplant recommendations (page not provided) say patients with metastatic disease and poor survival generally should not be considered for transplantation. But the Gynecologic Cancers recommendations allow consideration of high-risk patients after 3–5 years without recurrence, and the Colorectal Cancer recommendations allow transplantation for selected patients with liver metastases. The claim overstates these conditional recommendations as a blanket rule. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Transplantation may be considered in patients who have no metastasis and a very low risk of recurrence.

    “in those who have no metastasis and a very low risk of recurrence”

    From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [6]

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Authors
Al-Adra, D. P., Hammel, L., Roberts, J., Woodle, E. S., Levine, D., Mandelbrot, D., Verna, E., Locke, J., D’Cunha, J., Farr, M., Sawinski, D., Agarwal, P. K., Plichta, J., Pruthi, S., Farr, D., Carvajal, R., Walker, J., Zwald, F., Habermann, T., Gertz, M., Bierman, P., Dizon, D. S., Langstraat, C., Al-Qaoud, T., Eggener, S., Richgels, J. P., Chang, G. J., Geltzeiler, C., Sapisochin, G., Ricciardi, R., Krupnick, A. S., Kennedy, C., Mohindra, N., Foley, D. P., & Watt, K. D.
Affiliations
  • University of Wisconsin–Madison (US)
  • University of California, San Francisco (US)
  • University of Cincinnati (US)
  • The University of Texas at San Antonio Health Science Center (US)
  • University of Alabama at Birmingham (US)
  • Mayo Clinic (US)
  • University of Pennsylvania (US)
  • University of Chicago (US)
  • Duke University (US)
  • The University of Texas Southwestern Medical Center (US)
  • University of Alberta (CA)
  • Piedmont Atlanta Hospital (US)
  • University of Nebraska Medical Center (US)
  • Brown University (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Massachusetts General Hospital (US)
  • University of Virginia (US)
  • Northwestern University (US)
Corresponding author
Watt, Kymberly D.
Venue
American Journal of Transplantation
Publisher
Elsevier BV
Published
2021-02
Volume
21
Issue
2
Pages
460-474
ISSN
1600-6135 (ISSN-L)
OpenAlex
W3088257825
Cited by
163
References
96
Citations by year
2026: 26 · 2025: 39 · 2024: 29 · 2023: 30 · 2022: 17 · 2021: 19 · 2020: 3
FWCI
15.75
Type
journal article
Language
en
Open access
Locations
  • American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Sanofi
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
  • Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
Keywords
solid organ transplantation, transplant eligibility, tumor recurrence, immunosuppression, tumor staging, prognosis, breast cancer, colorectal cancer, anal cancer, genitourinary cancer, gynecologic cancer, non-small cell lung cancer, cancer therapy
MeSH terms
Humans, Neoplasm Recurrence, Local, Prognosis, Organ Transplantation

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