Wong Emmett Tsz Yeung, Liew Ian Tatt, Than Hein, Ho Aloysius Yew Leng, Nagarajan Chandramouli, Goh Yeow Tee, Chuah Charles Thuan Heng, Poon Michelle Limei, Chng Wee Joo, Ooi Melissa Gaik Ming, De Mel Widanalage Sanjay Prasad, Yeo Allen Eng Juh, Kee Terence, Vathsala Anantharaman
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore.
J Nephrol. 2025 Aug 22. doi: 10.1007/s40620-025-02381-8.
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.
已故捐赠者的肾脏是一种稀缺的国家资源，功利主义和正义原则指导着分配。与没有癌症病史的肾移植受者相比，有癌症病史的肾移植受者出现恶性肿瘤及非恶性肿瘤相关死亡的风险更高。移植前患有恶性肿瘤的受者生存率较低，这引发了对于将稀缺资源分配给预期患者和移植物生存率较差人群的质疑。然而，随着血液系统恶性肿瘤治疗方法的进步，患者生存率有了显著提高，这促使美国移植学会在2019年更新了专家共识意见。尽管如此，在已故捐赠者肾脏稀缺且等待时间较长的国家，移植前患有血液系统恶性肿瘤的患者的候选资格可能需要特殊考虑。本综述详细阐述了在新加坡优化稀缺的已故捐赠者器官供应的同时，对有血液系统恶性肿瘤病史的患者进行评估的依据以及将其列入已故捐赠者肾脏移植等待名单的候选资格建议。它考虑了器官稀缺是一个明显挑战的国家的现有证据；因此，本共识报告是针对这些限制条件制定的，可能无法完全推广到其他国家或移植分配算法。
