A World-Wide Survey on Kidney Transplantation Practices in Breast Cancer Survivors

The Need for New Management Guidelines

Keith S. Hansen; Hila Ghersin; Merisa Piper; Mehdi Tavakol; Brian Lee; Laura J. Esserman; John P. Roberts; Chris Freise; Nancy L. Ascher; Rita A. Mukhtar


American Journal of Transplantation. 2021;21(9):3014-3020. 

In This Article

Materials and Methods


Ethics approval was granted by the University of California San Francisco Institutional Review Board, study number 17–22238. A 19-item web-based survey was created with the UCSF Clinical and Translational Science Institute and hosted by Qualtrics. The survey included questions on (i) demographics including: age, sex, country (and state) of practice, years of practice, specialty, and practice setting; (ii) transplant evaluation volume and number of annual transplant candidates with a history of breast cancer; (iii) respondents' perceptions on performing kidney transplantation in candidates with a history of breast cancer; (iv) the relationship between immunosuppression and breast cancer recurrence; (v) respondents' perceptions on guidelines for performing kidney transplant in a patient with a pre-existing diagnosis of breast cancer; (vi) knowledge of and willingness to use molecular assays stratifying recurrence risk to guide decision-making. Geographic regions within the US were defined by grouping Organ Procurement and Transplantation Network regions as follows: regions 5 and 6 were considered "West"; regions 7, 8, and 19 were considered "Midwest"; regions 4, 3, and 11 were considered "South"; and regions 1, 9, and 2 were considered "East."

Between March 4, 2019, and April 25, 2019, the survey was distributed to 955 members of the American Society of Transplant Surgeons via email. The invitation e-mail included a detailed participant explanatory statement, and the link to the web-based questionnaire. The first e-mail reminder was sent to all participants 1 week after the initial invitation. A total of two e-mail reminders were sent within the survey period. Additionally, a brief study description and link to the survey were also included in the Tribune Pulse in the months of April and May 2019, a monthly newsletter published by The Transplantation Society, an international non-governmental organization. Survey participation remained anonymous. A summary of survey results was offered to participants who elected to share their identity.

Statistical Analysis

The data were downloaded from Qualtrics into Microsoft Excel. All statistical analyses were performed using Stata, version 14.2 (Stata Corp). Summary statistics were employed to report the findings. Chi square and Fisher's exact tests were used for categorical comparisons and analysis of variance for continuous comparisons. Two tailed p < .05 were considered significant.