Are We Late in the Diagnosis of Malignities Occurring in Solid Organ Transplant Patients? 11 Years’ Experience

Abstract

Objective: Our aim is to evaluate the frequency and characteristics of cancer in the population of patients with solid organ transplant who are under immunosuppressive medication. In this study we aimed to emphasize the importance of early diagnosis of cancer in solid organ transplant recipients. An aging population began to receive solid organ transplantation and survival times prolonged. But this had a cost and new problems came forward. Especially de novo cancers because of immunosuppressive therapy took notice. Risk of malignancy increases after organ transplantation and cancer incidence was about 2.3-3.1% in these patients including skin cancer, lung cancer, malign lymphoma, cervix cancer, kaposi sarcoma, and hepatobiliary cancer. Materials and Methods:The files of 328 organ transplant recipients followed from January 2004 to April 2015 at Atatürk University Medical Faculty were retrospectively reviewed.Results: Eight patients developed cancer (2.4%). There were six males and two females. Age at cancer diagnosis ranged from 42 to 79 years old with average of 55 years. The interval from solid organ transplantation to cancer diagnosis ranged from 6 months to 30 years. Among the patients, five were renal transplant recipients and two were liver transplant recipients. Four patients had stage IV disease, one patient stage IIIB, and three patients had stage I disease. For none of the patients a diagnosis with screening methods was used for cancer before any complaints of tumor emerged. Conclusion:To diagnose cancer at early stages in solid organ transplant recipients, earlier and detailed cancer screening is very important. The association between diagnosis of cancer at early stages and prolonged overall survival time is well known. Detailed and careful evaluation for occult malignancies in pre-transplantation period is also important. Keywords: Cancer, immunosuppression, screening, transplantation ÖzAmaç: Amacımız solid organ transplantı olan, immunsupresif tedavi altındaki hastalarda gelişen kanser sıklığını ve özelliklerini değerlendirmektir. Bu çalışmada, solid organ transplant alıcıla-rında gelişen kanserlerin erken tanısının önemini vurgulamayı amaçladık. Yaşlanan nüfusla birlikte artan solid organ transplantı ile hayatta kalma süreleri uzamıştır. Fakat bu durum yeni maliyetler getirmiş ve yeni sorunlara neden olmuştur. Özellikle immunsupresif tedavilerin sonucunda de novo kanserler görülme-ye başlamıştır. Organ nakli sonrası kanser riski artar ve en sık cilt kanseri, akciğer kanseri, malign lenfoma, serviks kanseri, kaposi sarkomu ve hepatobilier kanseri içeren bu grupta insidans %2,3-3,1'dir. Sonuç: Solid organ transplant alıcılarında erken evrede kanser tanısı için ayrıntılı ve erken kanser taraması çok önemlidir. Erken tanı ve tedavi ile uzun süreli genel sağkalım arasındaki ilişki iyi bilinmektedir. Nakil öncesi dönemde okült maligniteler için detaylı ve dikkatli bir değerlendirme de önemlidir. Gereç ve

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“…3 Solid-organ transplant increases the risk of malignancy three-to fourfold in SOT patients compared with the general population. 8 Pulmonary mass lesions and nodules are critical findings, especially in liver transplant recipients, and require early diagnosis and treatment. Afessa and colleagues identified several causes for a pulmonary mass: aspergillosis, cryptococcosis, metastatic hepatocellular carcinoma (HCC), posttransplant lymphoproliferative disorder (PTLD), Staphylococcus aureus, squamous cell carcinoma, and undifferentiated carcinoma.…”