Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation: A consensus expert opinion statement
Open accessAbstract
Patients undergoing evaluation for solid organ transplantation (SOT) frequently have a history of malignancy. Only patients with treated cancer are considered for SOT but the benefits of transplantation need to be balanced against the risk of tumor recurrence, taking into consideration the potential effects of immunosuppression. Prior guidelines on timing to transplant in patients with a prior treated malignancy do not account for current staging, disease biology, or advances in cancer treatments. To update these recommendations, the American Society of Transplantation (AST) facilitated a consensus workshop to comprehensively review contemporary literature regarding cancer therapies, cancer stage specific prognosis, the kinetics of cancer recurrence, as well as the limited data on the effects of immunosuppression on cancer-specific outcomes. This document contains prognosis, treatment, and transplant recommendations for melanoma and hematological malignancies. Given the limited data regarding the risk of cancer recurrence in transplant recipients, the goal of the AST-sponsored conference and the consensus documents produced are to provide expert opinion recommendations that help in the evaluation of patients with a history of a pretransplant malignancy for transplant candidacy.
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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 [7]
The Expert Opinion Transplant Recommendations section (page not provided) supports considering transplantation after remission for some patients with prior malignancy. It does not make more than five recurrence-free years a general criterion: recommended waits vary by cancer and stage, and advanced melanoma requires an individual decision even after five years. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTransplantation 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 [7]
The Expert Opinion Transplant Recommendations section recommends waiting at least five years for a high-risk melanoma group, supporting caution about recurrence. But it does not recommend categorically avoiding transplantation for metastatic disease: it calls for individual discussion even for stage IV patients. The cited passages also do not establish short life expectancy as a blanket reason to avoid transplantation. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTransplantation 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 [7]
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 [7]
The Expert Opinion Transplant Recommendations section discusses transplant candidacy for selected patients with melanoma, but does not identify a carcinoma that is not significantly affected by immunosuppression. Searches for carcinoma and for cancers unaffected by immunosuppression found no passage addressing that condition; the Malignant Melanoma section instead describes uncertainty about immunosuppression’s effect on recurrence. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Leard, L. E., Holm, A. M., Valapour, M., Glanville, A. R., Attawar, S., Aversa, M., Campos, S. V., Christon, L. M., Cypel, M., Dellgren, G., et al. (2021) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2021.07.005 · Cited by 821 · see citing works
“Malignancy with high risk of recurrence or death is an absolute contraindication, but it is increasingly acknowledged in the context of lung transplant that not all neoplastic diseases are equal.(13,14) Certain malignancies may not be significantly affected by immunosuppression and some may be managed post-transplant…”
BackgroundIndications for Lung Transplantation and Patient Selection
Son, J., & Shin, C. (2022) · Journal of Chest Surgery · doi:10.5090/jcs.22.057 · Cited by 9 · see citing works
“However, 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].”
Background
- 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.
- ORCID
- Al-Adra, David P.
- Roberts, John
- Woodle, E. Steve
- Levine, Deborah
- Mandelbrot, Didier
- Verna, Elizabeth
- Locke, Jayme
- Farr, Maryjane
- Sawinski, Deirdre
- Agarwal, Piyush K.
- Plichta, Jennifer
- Pruthi, Sandhya
- Farr, Deborah
- Carvajal, Richard
- Walker, John
- Zwald, Fiona
- Habermann, Thomas
- Gertz, Morie
- Dizon, Don S.
- Langstraat, Carrie
- Al-Qaoud, Talal
- Eggener, Scott
- Chang, George J.
- Geltzeiler, Cristina
- Ricciardi, Rocco
- Krupnick, Alexander S.
- Kennedy, Cassie
- Mohindra, Nisha
- Foley, David P.
- Watt, Kymberly D.
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 21
- Issue
- 2
- Pages
- 475-483
- ISSN
- 1600-6135 (ISSN-L)
- PMC
- PMC8555431
- OpenAlex
- W3088422310
- Cited by
- 87
- References
- 49
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 19 · 2023: 15 · 2022: 13 · 2021: 13 · 2020: 3
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Society of Transplantation
- Sanofi
- Topics
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- melanoma, hematologic malignancies, solid organ transplantation, transplant eligibility, tumor recurrence, immunosuppression, prognosis, tumor staging, cancer therapy, transplant recipient outcomes
- MeSH terms
- Humans, Melanoma, Neoplasm Recurrence, Local, Prognosis, Organ Transplantation, Hematologic Neoplasms
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