Malignancy in Renal Transplant Recipients

Jin Min Kong

doi:10.4285/jkstn.2009.23.2.130

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Kong: Malignancy in Renal Transplant Recipients

Review Article

J Korean Soc Transplant 2009;23(2):130-134.

Published online: 11 September 2009

DOI: https://doi.org/10.4285/jkstn.2009.23.2.130

Malignancy in Renal Transplant Recipients

Jin Min Kong, M.D.

Division of Nephrology, Maryknoll Medical Center, Busan, Korea

책임저자：공진민, 부산 중구 대청동 4-12 메리놀병원 신장내과, 600-730 Tel: 051-461-2393, Fax: 051-441-6950 E-mail: drkongj@gmail.com

Received 22 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

With improved management of infectious and cardiovascular complications of renal transplant recipients, prolonged survival with long-term follow up duration, and increasing age of patients, cancer became an increasingly important cause of morbid-ity and mortality in transplant patients. Literatures indicate three to fivefold incidence of malignancy in solid organ transplant recipients compared with that of general population. Certain types of malignancy, such as skin cancer, Kaposi's sarcoma, lymphoma, cervical, oral and anogenital cancer, hepatocelluar and renal cell carcinoma are particularly reported to be high in incidence. Reduction of immunosuppressive medication is the first step to be considered for the management, especially for virus-associated cancer. The inhibitor of mammalian target of rapamycin(mTORi) suppresses the growth and proliferation of tumors in various animal models, cured Kaposi's sarcoma and seems to reduce the incidence of de novo malignancies of renal transplant recipients, and is therefore a valuable option for the management of cancer of these patients without increment of the risk of graft rejection.

Keywords: Malignancy, Kidney transplantation, mTOR inhibitor, Cancer screening

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Table 1.

Guidelines for cancer screening in the general population recommended by the National Cancer Information Center, Korea, and U.S. and European guidelines for transplant population

	Screening program for 5 major cancers, by the National Cancer Information Center, Korea(29)	U.S. and European guidelines for transplant patients(30,31)
Stomach	Biennial barium radiography or gastroscopy for individuals older than 40 years	None
Liver	Abdominal USG and AFP every 6 months for those with liver cirrhosis, HBsAg(+) or anti-HCV(+)	No firm recommendation, but abdominal USG and AFP every 6 months in high risk recipients
Colon	Annual FOBT for individuals older than 50 years, If FOBT(+), then barium enema or colonoscopy	Annual FOBT and/or 5-yearly flexible sigmoidoscopy for those older than 50 years
Breast	Monthly self-exam for women older than 30 years, biennial mammography＋ exam by physician for women older than 40 years	Annual or biennial mammography for women older than 50 years
Cervix	Biennial cytological screening for women older than 30 years	Annual cytological screening and pelvic exam once sexually active
Prostate		Annual DRE and PSA measurement in men older than 50 years
Skin		Monthly self-skin exam, total body skin exam every 6∼12 months by expert physician or dermatologist
Renal tract		No firm recommendation, some suggested regular USG of the native kidneys

Abbreviations: USG, ultrasonography; AFP, alpha-feto protein; FOBT, fecal occult blood test; DRE, digital rectal examination; PSA, prostate specific antigen.

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