Journal List > J Korean Soc Transplant > v.23(2) > 1034282

Kong: Malignancy in Renal Transplant Recipients

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.

REFERENCES

1). Buell JF, Gross TG, Woodle ES. Malignancy after transplantation. Transplantation. 2005; 80(2S):S254–64.
2). Vajdic CM, McDonald SP, McCredie MR, van Leeuwen MT, Stewart JH, Law M, et al. Cancer incidence before and after kidney transplantation. JAMA. 2006; 296:2823–31.
3). Kasiske BL, Snyder JJ, Gilbertson DT, Wang C. Cancer after kidney transplantation in the United States. Am J Transplant. 2004; 4:905–13.
4). Webster AC, Wong G, Craig JC, Chapman JR. Managing cancer risk and decision making after kidney transplantation. Am J Transplant. 2008; 8:2185–91.
5). Stewart T, Tsai SC, Grayson H, Henderson R, Opelz G. Incidence of de-novo breast cancer in women chronically immunosuppressed after organ transplantation. Lancet. 1995; 346:796–8.
6). Vasudev B, Hariharan S. Cancer after renal transplantation. Curr Opin Nephrol Hypertens. 2007; 16:523–8.
7). Kim JY, Kim SH, Kim YS, Choi BS, Kim JC, Park SC, et al. Report of 1,500 kidney transplants at the Catholic University of Korea. J Korean Soc Transplant. 2006; 20:172–80.
8). Bok HJ, Kim BS, Park JH, Yang CW, Kim YS, Kim SY, et al. Clinical study of malignancies after allograft renal transplantation. Korean J Nephrol. 2000; 19:347–52.
9). Kim MS, Chang HK, Ju MK, Joo DJ, Kim SJ, Kim SI, et al. Chronologically different incidence of posttransplant malignancy in renal transplant recipients; 25 years experience in Korean single center. Transplantation. 2008; 86(2S):698.
10). Schwarz A, Vatandaslar S, Merkel S, Haller H. Renal cell carcinoma in transplant recipients with acquired cystic kidney disease. Clin J Am Soc Nephrol. 2007; 2:750–6.
11). Ramos E, Drachenberg CB, Wali R, Hirsch HH. The decade of polyomavirus BK-associated nephropathy: state of affairs. Transplantation. 2009; 87:621–30.
12). Swann PF, Waters TR, Moulton DC, Xu YZ, Zheng Q, Edwards M, et al. Role of postreplicative DNA mismatch repair in the cytotoxic action of thioguanine. Science. 1996; 273:1109–11.
13). Jensen P, Hansen S, M⊘ller B, Leivestad T, Pfeffer P, Fauchald P. Are renal transplant recipients on CsA-based immunosuppressive regimens more likely to develop skin cancer than those on azathioprine and prednisolone? Transplant Proc. 1999; 31:1120.
14). Dantal J, Hourmant M, Cantarovich D, Giral M, Blancho G, Dreno B, et al. Effect of long-term immunosuppre-ssion in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet. 1998; 351:623–8.
15). Webster AC, Woodroffe RC, Taylor RS, Chapman JR, Craig JC. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta- analysis and meta-regression of randomised trial data. BMJ. 2005; 331:810.
16). Ekberg H, Bernasconi C, Tedesco-Silva H, Vítko S, Hugo C, Demirbas A, et al. Calcineurin inhibitor minimization in the symphony study: observational results 3 years after transplantation. Am J Transplant. 2009; 9:1876–85.
17). Cherikh WS, Kauffman HM, McBride MA, Maghirang J, Swinnen LJ, Hanto DW. Association of the type of in-duction immunosuppression with posttransplant lympho-proliferative disorder, graft survival, and patient survival after primary kidney transplantation. Transplantation. 2003; 76:1289–93.
18). Robson R, Cecka JM, Opelz G, Budde M, Sacks S. Prospec-tive registry-based observational cohort study of the long- term risk of malignancies in renal transplant patients treated with mycophenolate mofetil. Am J Transplant. 2005; 5:2954–60.
19). Campistol JM, Eris J, Oberbauer R, Friend P, Hutchison B, Morales JM, et al. Sirolimus therapy after early cyclosporine withdrawal reduces the risk for cancer in adult renal transplantation. J Am Soc Nephrol. 2006; 17:581–9.
20). Mathew T, Kreis H, Friend P. Two-year incidence of malignancy in sirolimus-treated renal transplant recipients: results from five multicenter studies. Clin Transplant. 2004; 18:446–9.
21). Kauffman HM, Cherikh WS, Cheng Y, Hanto DW, Kahan BD. Maintenance immunosuppression with target-of- rapamycin inhibitors is associated with a reduced incidence of de novo malignancies. Transplantation. 2005; 80:883–9.
22). Schena FP, Pascoe MD, Alberu J, del Carmen Rial M, Oberbauer R, Brennan DC, et al. Sirolimus CONVERT Trial Study Group. Conversion from calcineurin inhibitors to sirolimus maintenance therapy in renal allograft recipients: 24-month efficacy and safety results from the CONVERT trial. Transplantation. 2009; 87:233–42.
23). Stallone G, Schena A, Infante B, Di Paolo S, Loverre A, Maggio G, et al. Sirolimus for Kaposi's sarcoma in renal-transplant recipients. N Engl J Med. 2005; 352:1317–23.
24). Campistol JM. Minimizing the risk of posttransplant malignancy. Transplantation. 2009; 87(8S):S19–22.
25). Stracke S, Ramudo L, Keller F, Henne-Bruns D, Mayer JM. Antiproliferative and overadditive effects of ever-olimus and mycophenolate mofetil in pancreas and lung cancer cells in vitro. Transplant Proc. 2006; 38:766–70.
26). Towler B, Irwig L, Glasziou P, Kewenter J, Weller D, Silagy C. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. BMJ. 1998; 317:559–65.
27). Tabàr L, Fagerberg CJ, Gad A, Baldetorp L, Holmberg LH, Gröntoft O, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985; 1:829–32.
28). U.S. Preventive Services Task Force. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002; 137:915–6.
29). National Cancer Information Center (NCIC). National Cancer Screening Program [Internet]. Goyang City: NICI;2007. Available from. http://www.cancer.go.kr/cms/checkup/mdical_examintion/index.html.
30). EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin cancers: prevention and treatment. Nephrol Dial Transplant. 2002; 17(S4):31–6.
31). Kasiske BL, Vazquez MA, Harmon WE, Brown RS, Danovitch GM, Gaston RS, et al. Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation. J Am Soc Nephrol. 2000; 11(S15):S1–86.
32). Ro H, Kim SM, Kim KW, Hwang YH, Yang JS, Oh KH, et al. Malignancy after Kidney Transplantation. J Korean Soc Transplant. 2006; 20:187–92.
33). Nojima M, Higuchi Y, Ueda Y, Yamamoto S, Shima H, Ihara H, et al. Malignancy after kidney transplantation in Japan. Transplantation. 2008; 86(2S):698.

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.

TOOLS
Similar articles