End stage renal disease (ESRD) patients in need of a kidney transplant who have a previous history of urological cancer should undergo a cancer-free waiting period before receiving a kidney transplant. Currently the recommended waiting time is based on the Cincinnati registry, which essentially considers the type of tumour and the time between its treatment and kidney transplantation. The waiting period varies from less than two years to at least five years according to the Registry. However, the authors argue that the Cincinnati Registry has several deficiencies: (1) the treatment and the staging of the disease are not defined, (2) the epidemiology of tumours, (3) the diagnostic and therapeutic procedures / tests have changed, and (4) the prognostic tools have improved. This systematic review questions the need for this waiting time by comparing cancer recurrence in end-stage renal failure (ESRF) patients, with a history of urological cancer, who either continued on dialysis or received a kidney transplant. Each group had a primary outcome of tumour recurrence, with secondary outcomes cancer-specific and overall survival. Results collectively contain 2519 patients (1733 dialysis and 786 kidney transplant). The authors concluded that kidney transplantation and subsequent immunosuppression does not affect outcomes or the natural history of low-risk renal cell carcinoma or prostate cancer. Therefore a shorter kidney transplant waiting time is appropriate in these patients. Due to limited data they felt that the Cincinnati Registry should be followed for high-risk prostate and high-risk renal cell cancer and testicular cancer. Upper urinary tract urothelial cancer (UUTUC) had a synchronous bilateral incidence of 10-16% and contralateral recurrence risk of 31-39%. With this high a risk recommendations were either contralateral nephroureterectomy, possibly including cystectomy, or very close monitoring of the contralateral urinary system post transplant.

The risk of tumour recurrence in patients undergoing renal transplantation for end-stage renal disease after previous treatment for a urological cancer: a systematic review.
Boissier R, Hevia V, Bruins HB, et al.
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Nishant Bedi

Northwick Park Hospital.

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