EURURO Vol. 73 No. 1

109 148

Platinum Priority – Editorial
Referring to the article published on pp. 94–108 of this issue
Renal Transplantation After Treatment for a Urological Cancer:
Who and When? Does Evidence Help for a Challenge?
Javier Burgos-Revilla [1_TD$DIFF] [2_TD$DIFF]
Department of Urology, Ramon y Cajal Hospital, Alcala University[3_TD$DIFF], IRYCIS, Madrid, Spain
In this month's issue of European Urology, Boissier et al
take on the daunting task of summarizing the available
evidence on the risk of cancer recurrence in end-stage renal
disease (ESRD) patients who underwent kidney transplan-
tation (KT) after having been successfully treated for a
urological cancer .
Malignancy is a major cause of death after kidney KT.
However, the role of pretransplantation history of malig-
nancy in patient survival is a controversial issue.
A worse outcome in KT recipients (KTRs) with pre-
transplantation malignancy has been reported, regardless
of whether their cancer recurred or not . Neoplasia
history previous to KT has been referred to as an
independent risk factor for post-transplantation death
due to malignancy One large nationwide study in
Sweden showed that KTRs with a history of cancer had a
30% increased rate of death compared with those without
cancer history KTRs with a pretransplant cancer history
have a 3–7-fold increased risk of cancer mortality compared
with KTRs without such history . The recipient mortality
due to malignant recurrence ranges in the literature
between 3.5% and 13.7% .
On the contrary, Viecelli et al reported that a history of
previous malignancy does not have an additive effect on the
cancer-specific and overall mortality rates. Recently, Dahle
et al referred that KTRs with a pretransplant cancer had a
similar overall patient and graft survival as recipients without
such cancer, although cancer mortality was increased,
particularly during the 1st 5 yr after transplantation.
In the past, before transplantation could be considered in
a cancer survivor with ESRD, a 5-yr period without any
evidence of disease was mandatory. However, many major
cancers recur within 2 yr of treatment, thus a minimum of
2 yr was recommended. A 2-yr waiting period would
eliminate only 13% of colorectal recurrences, 19% of breast
cancer recurrences, and 40% of prostatic cancer recurrences.
In contrast, a 5-yr waiting period would eliminate most
recurrences, but this period is unnecessary for most tumors
[5_TD$DIFF] .
Most of these criteria were established mainly based on
the data of the Cincinnati Transplant Tumor Registry, that
defined three different recurrence risk groups in basis to
recurrence rate: low ( [1_TD$DIFF]7%), intermediate (11–21%), and high
(>[1_TD$DIFF]23%) .
As Boissier et al argued in their article, Cincinnati
Transplant Tumor Registry criteria must be updated,
because many diagnostic, therapeutic, and prognostic
aspects have changed in the last few years. Therefore, there
is not enough evidence to support a fixed waiting period
before transplantation.
The influence of thewaiting period in the risk of recurrence
is not well established. A short waiting period between cancer
treatment and transplantation has been identified as a risk
factor for recurrence and mortality . However, a recent
Norwegian study defending a policy of a “short waiting
period” (1 yr) between cancer treatment and KT, yields an
overall survival similar to KTRs without a cancer history.
Moreover, the authors found no association between the
waiting period and recurrent cancer or all-cause mortality .
Guidelines recommends a 2–5-yr waiting period between
cancer treatment and transplantation, depending on the type
of cancer, although there is a great discrepancy in guidelines
and low level of evidence to support a fixed waiting period
(grade: C and level of evidence: 4) . Recipients who have
ava ilable at
journal homepage:
DOI of original article:
* Corresponding author. Department of Urology, Ramon y Cajal Hospital, Alcala University, Carretera de Colmenar, Km. 9, 10028034 Madrid, Spain.
Tel. +34 913368760; Fax: +34 913368766.
E-mail address: (J. Burgos-Revilla).
0302-2838/© 2017 Published by Elsevier B.V. on behalf of European Association of Urology.