EURURO Vol. 73 No. 1

110 148

tumors with a low recurrence rate can be considered for
immediate transplantation, after successful treatment of the
tumor. In the remaining cases, because of the risk of dormant
metastases, the waiting period should be individualized
according to the type and TNM stage and grade of the tumor,
age, and recipient's general condition .
Increased mortality in patients with pretransplant
malignancy and short waiting periods is not predominantly
due to cancer recurrence deaths. In fact, cancer recurrence
deaths seemed to occur regardless of the waiting period .
An additional aspect is that most people with ESRD and
cancer are elderly. An anticipated additional waiting period
of 2–5 yr will often lead to death, not due to cancer but due
to the burden of dialysis treatment.
Modification of immunosuppression may be considered
in these patients. Reduction in immunosuppressive therapy
and the use of mechanistic target of rapamycin inhibitors
are associated with a reduced incidence of malignancy .
Recipients with a pretransplant cancer had a similar
overall patient and graft survival as recipients without such
cancer. Although cancer mortality is increased, particularly
during the 1st 5 yr after transplantation, a short waiting
period from cancer treatment to transplantation is not
associated with all-cause or cancer recurrence mortalities,
withmost data in recipients with a history of renal, prostate,
and urothelial cancer
Conflicts of interest: The authors have nothing to disclose.
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