Waiting time for patients with history of malignant disease before listing for organ transplantation

With increasing age of patients listed for organ transplantation the issue of preexisting malignomas in remission becomes more relevant. Because immunosuppressive therapy is associated with a remarkable increase in malignant disease, the current notion is that a history of malignancy puts the patient at high risk for relapse after transplantation. However, there is little reliable evidence that immunosuppression uniformly alters the risk of a patient with malignancy in remission. Therefore, the choice of a waiting time may prevent the patient from getting his inevitable tumor relapse after transplantation. Whether or not the relapse results in a worse prognosis compared to non-transplanted patients is not clear, either. On the background of this incomplete knowledge the decision to list a patient with a history of malignancy needs to be an individual one, taking into account the prognosis of the particular tumor, stage and original extent of disease as well as the overall prognosis of the patient if transplantation is withheld. Waiting times listed for different tumor entities by scientific societies are helpful; however, sometimes the individual decision needs to deviate from these suggestions. The recommendations are based on the Cincinnati Transplant Tumor Registry collecting data on malignancies related to transplantation. Even in this worldwide registry the number of cases for most tumor entities is small and does by far not cover all stages of disease. These data are an important part of decision making in order to determine whether it is best for the patient to be listed for transplantation or not.