Malignancy in a Potential Kidney Allograft Recipients-How Important is the Problem?

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The optimal renal replacement therapy is kidney transplantation because it improves quality of life, prolongs survival, and is cost-effective. However, it also bears a risk of malignancy due to immunosuppressive therapy. The aim of this study was to examine demographic and comorbidity, including history of malignancy in patients with end-stage renal disease on the kidney transplantation waiting list in regard to their status (active vs temporarily disqualified, active vs inactive).The cross-sectional study was conducted in 281 prevalent patients (over 1/3 population the waitlisted in the country). Data analysis was based on the clinical and laboratory parameters enclosed in the registration form for kidney transplantation.Patients who had been registered in the cadaver kidney waiting list were aged 50±12 in the average, with a balanced sex ratio, median dialysis duration was 39 months, mean BMI was 27±5 kg/m2, median residual renal function was 500 ml, prevalence of hepatitis B and C was below 3%, with hepatitis C being more prevalent than B (p<0.001). The leading cause of ESRD was chronic glomerulonephritis, followed by diabetic nephropathy and ADPKD. When patients were analyzed in regard to their status on the waiting list (active or temporarily non-active) total cholesterol, LDL cholesterol, aspartate aminotransferase were lower and weakly dialysis dose was higher in patients on the active list vs non-active. Clinical status, including cardiovascular status (echocardiography parameters, coronary angiography results) were similar in both groups. In the screening period history of malignancy or active malignancy was present in 50% of patients and they were temporarily disqualified. After careful evaluation, oncology consult and assessment of waiting time before enlistment 31% of the patients were outlisted (inactive status).Concluding, malignancy became a serious problem in potential kidney allograft recipients. As detailed guidelines are not available, therefore, personalized approach (oncology consult or other specialists consult) in patients with history of malignancy and active malignancy is prerequisite. After careful evaluation patients could be waitlisted taking into consideration prior history, treatment and time elapsed from the diagnosis in order to yield the best possible outcomes.

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