Deceased donor kidney transplantation in candidates with pre-transplant hematological malignancies: a literature review and recipient allocation proposal in Singapore.

Abstract

Deceased donor kidneys are a scarce national resource, and principles of utilitarianism and justice govern allocation. Kidney transplant recipients with a prior history of cancer show an increased risk of malignancy- and non-malignancy-related mortality compared to their counterparts without a previous history of malignancy. The inferior survival of a recipient with pre-transplant malignancy questions the allocation of a scarce resource to a population at anticipated poorer patient and graft survival. However, patient survival has significantly improved with advances in therapeutics for hematological malignancies, which led to an updated consensus expert opinion by the American Society of Transplantation in 2019. Nevertheless, the candidacy of patients with pre-transplant hematological malignancies in countries with a scarcity of deceased donor kidneys and a prolonged wait time may warrant specific considerations. This review details the basis for evaluation and candidacy recommendations for patients with a history of hematological malignancy for waitlist placement for deceased donor kidney transplantation, while optimizing scarce deceased donor organ supply in  Singapore. It considers the available evidence in countries where organ scarcity is a distinct challenge; thus, this consensus report is tailored to these constraints and may not be fully generalizable to other countries or transplant allocation algorithms.