Cancer recurrence after solid organ transplantation: A systematic review and meta-analysis.
Acuna SA, Huang JW, et al.Transplantation Reviews 2017; 10: 10.
Aims
A systematic review was conducted to determine the cancer recurrence rate in solid organ transplant recipients with a pre-transplant malignancy (PTM).
Interventions
The databases Medline, Embase, and the Cochrane Library were searched from inception until week 2 of December 2016. Thesis dissertations and grey literature were also searched and citation tracking was used to identify studies missed by the search process. Included studies reported cancer recurrence in solid organ transplant recipients with PTM and were published in English, French, Spanish, or Portuguese. Two investigators independently assessed all titles and abstracts for eligible studies and reviewed full-text articles of all included citations.
Participants
57 studies were included in this systematic review.
Outcomes
Outcomes measured included cancer recurrence, site-specific cancer rate, and time from cancer diagnosis to organ transplantation.
Follow-up
Ranged from 1.08 to 14.25 years
CET Conclusions
This well-designed and interesting review synthesized the evidence for cancer recurrence in solid organ transplant recipients with a pre-transplant malignancy. The thorough search strategy was developed with the help of an information specialist. Random-effect models were used to pool data and heterogeneity was explored by a priori defined subgroup and sensitivity analyses. The review included 57 studies of which 39 could be pooled in meta-analyses. About half of the studies were considered to be of good quality according to an 18-item validated tool for assessing the quality of observational studies assessed by two independent reviewers. Studies were on kidney (n=19), heart (n=11), liver (n=7), lung (n=3) or various organs (n=17). Thirty-nine studies reported the length of follow-up which ranged from 1 to 14 years. The overall cancer recurrence rate was 1.6 events per 100 years. The rate was lowest for liver transplant recipients (1.0 event per 100 person years) and highest for kidney transplant recipients (2.4 events per 100 years). The authors conclude that their cancer recurrence estimates were lower than previously reported registry data.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO - 42015016961