悪性腫瘍の既往歴があるレシピエントに対する腎移植の適応—がん治療の進歩に伴う待機期間の変化

抄録

Candidates with a history of pretransplant malignancy (PTM) face increased risks of cancer recurrence and impact on survival rates due to the immunosuppression required after kidney transplantation. From the perspective of optimal utilization and fair allocation of organs donated after brain death or circulatory death, it is crucial to establish an appropriate waiting period following cancer treatment. This waiting period should decided based on the primary lesion, histology, stage of the PTM, and the latest treatment outcomes. This paper examines the changes in waiting periods and eligibility criteria for kidney transplantation in candidates with a history of PTM, as informed by guidelines from the 2000s and 2010s, and recommendations from the 2019 Consensus Workshop by the American Society of Transplantation.

When determining transplant eligibility and appropriate waiting periods for candidates with a history of PTM, decisions should not be based solely on traditional guidelines. Instead, they need to consider the latest cancer treatment outcomes, the risk of cancer recurrence under immunosuppression, and the most current knowledge about treating recurrent cancer. This decision-making process should involve not only transplant physicians but also specialists from the relevant oncology departments, oncologists, and the patients and their families.