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Transplant Rev (Orlando). 2018 Jan;32(1):29-35. doi: 10.1016/j.trre.2017.10.002. Epub 2017 Nov 8.

Cancer evaluation in the assessment of solid organ transplant candidates: A systematic review of clinical practice guidelines.

Author information

1
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.
2
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.; Ryerson University, Daphne Cockwell School of Nursing, Toronto, Canada.
3
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.
4
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, Canada.
5
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: BaxterN@smh.ca.

Abstract

BACKGROUND:

Active malignancies are a contraindication to transplantation, as immunosuppression can lead to worse cancer outcomes; therefore, ensuring transplant candidates are free of malignancy before transplantation is essential. This systematic review assesses the availability, quality, and consistency of recommended cancer evaluation prior to transplantation in Clinical Practice Guidelines (CPGs) for the selection of solid organ transplant candidates.

METHODS:

We systematically searched for CPGs for the assessment of transplant candidates. The characteristics of included CPGs, strength of recommendations and supporting evidence were extracted. A quality assessment of the CPGs was conducted using the AGREE II tool.

RESULTS:

We identified 52 CPG for the selection of solid organ transplant candidates. Only 13 (25%) included recommendations for cancer evaluation as part of the assessment of transplant candidates. Most recommended age and sex appropriate cancer screening as per the general population guidelines. Recommendations to evaluate for other malignancies and for high-risk candidates were variable. Most recommendations were based on expert opinion and only two CPGs provided an explicit link between the recommendations and supporting evidence.

CONCLUSION:

There is a lack of clear and consistent recommendations for pretransplant cancer evaluation in existing CPGs. Although there is some consensus regarding the indication to screen for cancer as per the recommendations for the general population, these recommendations are not an appropriate risk reduction strategy for transplant candidates. Standardized protocols to ensure transplant candidates are cancer free prior to transplantation are needed.

PMID:
29169958
DOI:
10.1016/j.trre.2017.10.002
[Indexed for MEDLINE]

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