Kidney Transplantation - Practical Guide to Address Common Myths in the Pre– and Post–kidney Transplant Management of the Elderly Patient with Cancer - An Opinion Paper

Sep 23, 2026

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Two clinically important overlaps between kidney transplantation and oncology persist with uncertainty and bias: transplant candidacy for elderly patients with historic or active cancers or premalignant conditions, and cancer management in elderly kidney transplant recipients. These distort decisions and contribute to inadvertent inequities for older candidates with malignancy histories or current disease. The paper integrates patient viewpoints and oncologic perspective to propose a nuanced multidisciplinary strategy that looks beyond chronological age and centers individualized goals and care planning.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Aging and kidney disease burden

Transplant candidacy and access disparities

Age-related biases and selection practices

Cancer and immunosuppression concerns

Kidney Transplantation Practical Guide to Address Common Myths in the Pre– and Post–kidney Transplant Management of the Elderly Patient with Cancer: An Opinion Paper Mary Ann Lim , MD, FASN, FAST,1 Naoka Murakami, MD, PhD,2 Christopher D. Blosser, MD,3 Salma Shaikhouni, MD,1 Darshana M. Dadhania, MD, MS,4 Evan T. Hall, MD, MPhil,3 Krista Havlin, MSN, ANP, FNP,5 Arpita Basu, MD, MPH6 | Abstract. Two areas of overlap between kidney transplantation and oncology that remain fraught with uncertainty and bias are (1) transplant candidacy for elderly patients with historic or active cancers or premalignant conditions, and (2) managing cancer in elderly kidney transplant recipients. These have led to inadvertent inequities in the care of elderly kidney transplant candidates with historic or active malignancies. Incorporating a patient’s viewpoint and an oncologist’s perspective, we present a nuanced, multidisciplinary approach to management that goes beyond mere consideration of chronological age and focuses on the individual patient and his/her goals. | | --- | | (Transplantation Direct 2026;12: e1934; doi: 10. 1097/TXD.0000000000001934.) | INTRODUCTION As the population ages, the proportion of individuals 70 y or older living with kidney disease is also steadily growing. Kidney transplant (KT) remains the optimal therapy for eligible older adults (older than 70 y ) with advanced or endstage kidney disease, offering better survival and quality of life than remaining on dialysis while achieving comparable posttransplant outcomes to those seen in younger KT recipients.1 In the past decade we have observed a 2- to 3-fold Received 24 December 2025. Revision received 24 December 2025. Accepted 2 February 2026. 1 Department of Medicine, University of Pennsylvania, Philadelphia, PA. 2 Department of Medicine, Washington University in St. Louis, St. Louis, MO. 3 Department of Medicine, University of Washington, Fred Hutch Cancer Center, and Seattle Children’s Hospital, Seattle, WA. 4 Department of Medicine, Weill Cornell Medical College, New York, NY. 5 Patient Partner. 6 Department of Medicine, Emory School of Medicine, Atlanta, GA. C.D.B. acknowledges fees related to Advisory Board member for Pierre Fabre. A.B., C.D.B., D.M.D., M.A.L., N.M., and S.S. participated in concept, design, and writing of article. E.T.H. and K.H. participated in article writing. Correspondence: Mary Ann Lim, MD, FASN, FAST, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Ravdin Courtyard, 3400 Spruce St, Philadelphia, PA 19104. (maryann.lim@pennmedicine.upenn. edu). Copyright © 2026 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ISSN: 2373-8731 DOI: 10. 1097/TXD.0000000000001934 increase in the number of adult recipients older than 70 y, who have received a KT.2 Chronological age is no longer thought to be a contraindication for KT and transplant centers are increasingly willing to transplant higher risk KT candidates, despite this, disparities in access to transplant among KT recipients 70 y and older have remained.3-5 KT rates consistently lag behind the kidney disease burden observed in older KT candidates,6 with KT rates of only 3.34 per 100 person-years among individuals aged 65–74 y, and 0.5 per 100 person-years among those aged 75 y and older.7 Current guidelines allow transplant centers to weigh patient and clinical characteristics, which amplifies age-related biases. Transplant centers often follow stricter selection guidelines for older patients, given concerns for shorter life expectancy and fear of higher peri- and posttr

FAQs

Which two areas does the paper identify as overlapping between kidney transplantation and oncology?

It highlights (1) transplant candidacy for elderly patients with historic or active cancers or premalignant conditions, and (2) managing cancer in elderly kidney transplant recipients.

How do age-related biases affect access to kidney transplant for older adults?

Despite guidelines allowing consideration of clinical characteristics beyond chronological age, transplant centers often use stricter selection for older patients due to concerns about life expectancy and complication risk, contributing to lower listing and transplantation rates.

Why is cancer status a major concern in elderly kidney transplant candidates?

Pretransplant malignancy can restrict access to waitlisting and transplant because of fears about recurrence under immunosuppression, rules around cancer-free wait time, and provider bias about expected posttransplant outcomes.

Sep 23, 2026

Uploaded by Bintang