Thread by @renalpages

As a jobbing nephrologist a great deal of my time goes towards preparing patients for #kidney#transplants with #covid19 happening I hadn’t realised this @gokdigo Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation was out

These are my notes from a @isneducation webinar on kidney transplantation and cancer

kdigo.org/wp-content/upl…

For patients – the development of cancer is an important outcome as seen in the @song_initiative

Its common knowledge that the longer the vintage of the transplant recipient the higher the risk of developing malignancy -
anzdata.org.au/wp-content/upl…
And of course the incidence of some cancers is >others

Mortality depends on the site of the cancer

Among patients with ESRD, cancer risk is affected by kidney dysfunction and by immunosuppression after transplant. For many cancers, incidence remains high than in the general population across all intervals.

These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention

jasn.asnjournals.org/content/27/5/1…

Is there a strategy to prevent cancer therefore in transplant recipients? @WHO has defined a set of essentials that must be met for cancer screening but this evidence does not necessarily relate to the transplant population

A reminder of the rationale behind clinical practice guidelines

So what are the @goKDIGO guidelines?

Remember that renal characteristics may lead to false positives as in breast cancer screening - go.gale.com/ps/anonymous?i…

But some screening tests better than others such as FOB for bowel cancer where a negative test may rule out the diagnosis of colorectal cancer within 2 years.

However, the risk of major complications from work-up colonoscopy are at least ten-fold higher than in the general population.

europepmc.org/article/med/31…

For screening for lung cancer

cochrane.org/CD001991/LUNGC…

Screening for renal cell cancer

So Is routine screening cost effective?

academic.oup.com/ndt/article/26…

most women with advanced CKD do not receive breast or cervical cancer screening and concluded a better understanding of patient and health professional preferences toward cancer screening in CKD is needed along with the outcomes of such screening

cjasn.asnjournals.org/content/12/1/95

What about potential transplant candidates with prior cancer – when should they be transplanted?

journals.lww.com/transplantjour…

And what is survival with prior cancer in transplant patients?
This study shows Kidney transplant recipients with a pretransplant cancer had a similar overall patient and graft survival as recipients without such cancer.

Cancer mortality was increased, particularly during the first 5 years after transplantation. A short waiting period was not associated with mortality

journals.lww.com/transplantjour…

The risk of cancer recurrence in recipients with Post transplant malignancy is considerably lower than historic reports.
Evidence to support minimum cancer remission times before transplantation is limited.
ncbi.nlm.nih.gov/pubmed/28867291

The @goKDIGO recommendations are

A framework for future research in this important topic for clinician’s patients and donors alike in the document

thanks @ISNeducation for yet another useful webinar with practical information :)