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Kidney insufficiency and immunosuppression are well established contributors of tumor development, both before and after kidney transplantation. Patients with pre-transplant malignancies (PTM) are at risk of tumor recurrence and of the development of an unrelated tumor after transplantation. In this retrospective study of a German patient cohort, we analyzed 1089 patients that underwent kidney transplantation to determine the frequency, recurrence rate and overall survival of patients with pre-existing tumors across a 10-year period. PTM were found in 5.79% of the patients and appeared at a mean time of 7.39 (SD 6.8) years before transplantation. The tumors were most frequently of urologic (41.43%) origin, followed by malignancies of the skin (25.71%) and gynecologic tumors (10%). Tumor recurrence was observed in one case (1.6%) where the patient died of metastatic spinocellular carcinoma. Patients with pre-existing malignancies had a statistically significantly worse overall survival compared to transplant recipients without tumors (HR = 2.71, 95% CI 1.49–4.969). However, these differences could be entirely ascribed to the age (HR = 1.06, 95% CI 1.04–1.08) and gender (HR = 1.67, 95% CI 1.11–2.52) of the patients. We found that there was no difference in cancer-specific mortality or posttransplant cancer rate between patients with and without pre-existing malignancies (HR = 0.94, 95% CI 0.21–4.26).

Supplemental material, sTab_all_revised for All-cause and cancer-specific overall survival in kidney transplant recipients with pre-transplant malignancies in a German cohort by Fabian Jacoby, Holland-Letz Tim, Martin Zeier and Susanne Delecluse in Journal of Onco-Nephrology

Additional file 1: Figure S1. PIQOR microarray assay reveals strong expression of S100A8 and S100A9 in melanoma metastases. Figure S2. S100A8/A9 predicts overall survival in stage III and in stage IV melanoma patients. Figure S3. Combinatory analysis of S100B and LDH with S100A8/A9 in serum of stage III and stage IV patients of the combined training and independent validation sets. Figure S4. Survival analysis of serum S100A8/A9 in stage III patient with normal levels of LDH or S100B. Table S1. Main characteristics of the tissue microarray sets. Table S2. Main characteristics of the serum marker sets. Table S3. Multivariate analysis of serum marker proteins and overall survival in stage III patients of the combined training and independent validation sets. Table S4. Multivariate analysis of serum marker proteins and overall survival in stage IV patients of the combined training and independent validation sets. Table S5. Main characteristics of the pembrolizumab sets.