Outcomes of Solid Organ Transplant Recipients With Preexisting Malignancies in Remission: A Systematic Review and Meta-Analysis.
Acuna SA, Huang JW, et al.Transplantation 2017; 101(3): 471-481.
Aims
To conduct a systematic review to determine whether differences in survival and incidence of post transplant de novo malignancies exist between recipients with pretransplant malignancy (PTM) and those without PTM.
Interventions
The databases Medline, Embase, and the Cochrane Library were searched from inception until week 3 of December 2015. Titles and abstracts for eligible studies were independently assessed by two investigators and studies were included if they reported on at least one of the included outcomes.
Participants
33 studies were included in the narrative summary and 23 were included in the meta-analysis.
Outcomes
The primary outcome measured was all-cause mortality in solid organ transplant recipients (SOTR) with and without PTM. Secondary outcomes measued included cancer-specific mortality and the incidence of post-transplant de novo malignancy.
Follow-up
Variable
CET Conclusions
This is a well conducted and well written systematic review of pre-transplant malignancy and its association with post-transplant outcomes. The authors concluded that pre-transplant malignancy was significantly associated with a great risk of all-cause mortality (HR=1.51), cancer-specific mortality (HR=3.13), de novo malignancy (HR=1.92) and de novo non-melanoma skin cancer (HR=4.64) after transplantation. Paediatric patients with pre-transplant malignancy did not have a significantly increased risk of all-cause mortality after transplantation, although there was only one study looking at this population. Adults over 60 with pre-transplant malignancy did have a significantly increased risk of all-cause mortality (HR=5.0, one study). Despite these worse outcomes after transplantation, the authors do stress that increasing waiting times after successful cancer treatment will probably not improve outcomes in this group of patients.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO - 42014009155