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

Attitudes

Participants were asked to rank the importance of the following factors in their decision to require a waiting period prior to kidney transplantation for patients with a history of breast cancer: concern about breast cancer recurrence, concern about wasting an organ, concern about being sued, and transplant society or institutional guidelines. Most respondents (64.6%) rated concern about breast cancer recurrence as extremely important in their decision-making about wait times. Ratings about the importance about wasting an organ in decision-making varied more widely: 25.5% rated it moderately important, 21.8% rated it very important, and 20% rated it slightly important. 56.9% of respondents ranked the concern of being sued as not at all important to their decision-making about a waiting period for transplantation. 31.2% of respondents rated transplant society/institutional guidelines as very important, while 31.2% of respondents rated it as moderately important in their decision not to perform an immediate transplant.

Beliefs about the relationships between immunosuppression and cancer recurrence varied. 64.5% of participants believed immunosuppression causes a small increase in cancer recurrence, 19.0% believed immunosuppression causes a large increase in cancer recurrence, and 16.5% believed immunosuppression does not have a significant effect on breast cancer recurrence. There was a significant association between beliefs about immunosuppression and opinions about waiting times; of those surgeons who would consider immediate transplantation after breast cancer diagnosis 53.9% believed that immunosuppression does not impact breast cancer recurrence, versus 14.1% of those who recommend a 1–5 years waiting period, and 8.6% of those who recommended a waiting period >5 years (p = .001). Respondents who believed immunosuppression does not have a significant impact on breast cancer recurrence were more likely to consider foregoing the waiting period prior to kidney transplantation, while those who believed immunosuppression causes a large increase in recurrence were more likely to recommend a waiting period that is greater than 5 years (Figure 2).

Figure 2.

Relationship between beliefs regarding immunosuppression and cancer recurrence and minimum required waiting periods. Respondents who believe that immunosuppression does not increase the risk of cancer recurrence were significantly more likely to consider an immediate transplant for patients with a history of breast cancer. Respondents who believed immunosuppression causes a large increase in the risk of breast cancer recurrence were more likely to recommend a minimum waiting period of 5 years or more

The majority (75%) of respondents felt that current guidelines are inadequate to guide decision-making regarding kidney transplantation for women with breast cancer. Reasons for deeming current guidelines inadequate include the following: 31% of respondents believed current guidelines are outdated, 27.9% believed they are not evidence-based, 20.9% believed they are overly simplistic, and 17.8% believed they are inconsistent.

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