Recommended wait time for SOT candidates with a prior history of rectal cancer

Risk/stage	Recurrence-free survival 5 years (%)	Time interval to transplant	Additional considerations
Low risk Stage I (T1 or T2, N0, M0) Full oncologic resection	85 to 88	1 year, consider 2 years if high-risk features present	Low-risk features: Deficient DNA mismatch repair (as reflected by high levels of MSI) without BRAF mutation Upper 1/3 rectum or rectosigmoid High-risk features: LVI or PNI Mucinous or signet histology Poorly differentiated histology Bowel obstruction Tumor perforation <12 lymph nodes examined Lower 1/3 of rectum Incomplete mesorectal excision Tumor deposits considered as N+ disease. Patients with stage II and III disease should complete trimodality treatment (chemoradiotherapy, surgery and chemotherapy) unless elimination of one of these is deemed appropriate after multidisciplinary discussion. For patients who have undergone preoperative radiotherapy, response to treatment is highly prognostic. Complete and nearly complete responders have much lower risk for recurrence than those with poor response.
Low intermediate risk Stage I (T1, N0, M0) Local excision	78 to 88	2 years
High intermediate risk Stage II (T3 or T4, N0, M0) Stage III (Any T, N+, M0)	70	3 years, 5 years if high-risk features present
High risk Stage IV (Any T, Any N, M+)	14	5 years NED	SOT not recommended prior to 5 years; refer to special consideration regarding resectable CRC metastasis

RFS: recurrence-free survival; LVI: lymphovascular invasion; PNI: perineural invasion; MSI: microsatellite instability; CT: computed tomography; CAP: chest, abdomen, and pelvis; CEA: carcinoembryonic antigen; NED: no evidence of disease.

From: Al-Adra DP, Hammel L, Roberts, J, et al. Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement. Am J Transplant 2021; 21:460. https://onlinelibrary.wiley.com/doi/10.1111/ajt.16318. Copyright © 2021 John Wiley & Sons Ltd. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

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Recommended wait time for SOT candidates with a prior history of rectal cancer