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

Disclosures

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

In This Article

Practice

When asked how to manage waitlist time for a kidney transplant candidate with a history of breast cancer, respondents had a wide range of recommendations: 15.5% of respondents would consider eliminating a waiting period and proceeding immediately to transplantation regardless of time since cancer diagnosis, 55.8% would only consider transplantation after a remission period of 1–5 years, 27.1% would require a remission period greater than 5 years, and 1.6% would never perform kidney transplantation in a patient with prior breast cancer. To inform these decisions, 59.7% of participants would follow published transplant society guidelines, while 16.8% would follow institutional guidelines, and 11.6% would use their clinical judgment. The average number of years since completion of fellowship was significantly shorter in those who followed published or institutional guidelines compared to those who do not follow guidelines (16.2 vs. 21.4 years since fellowship, p = .011). Some participants (9.3%) stated that they needed information about tumor biology such as estrogen receptor (ER) status, tumor grade, and stage to accurately answer this question. There was no association between the recommended waiting period and transplant center volume, surgeon age, years since finishing fellowship, gender, familiarity with breast cancer molecular assays, or practice setting. However, there was a significant association between geographic location and recommended wait times.

Surgeons outside the US were significantly more likely to consider kidney transplantation in a breast cancer patient without a waiting period (29% vs. 11.2% respectively, p = .017). Within the US, 29.2% of surgeons in the Western Region would consider omitting the waiting period as compared to 3.6% of surgeons in the East, 13.6% of surgeons in the Midwest, and 0% of surgeons in the South (p = .004) (Figure 1). Additionally, 7.1% of respondents from the East reported that they would never offer kidney transplantation to a patient with prior breast cancer, versus no respondents in other US regions.

Figure 1.

Respondents' recommended waiting period for kidney transplantation following treatment of breast cancer based on geographic region within the United States. Management of kidney transplant candidates with a history of breast cancer varies by geographic location in the US. Respondents in the West are significantly more likely to consider an immediate transplant, while respondents in the South and East are more likely to require a remission period of 5 or more years

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