Clinical course of malignancies in renal transplant recipients

Abstract

Background. The incidence of cancers after renal transplantation is significantly higher than in populations that have not undergone transplantation. The authors report a group of renal transplant patients from the University of Cincinnati who had cancer develop; the focus is on the patients' clinical course. Methods. Since 1968, 876 renal transplantations have been performed for a variety of causes of end stage renal disease. Charts of transplant patients who had neoplasms were reviewed. Results. Forty‐four patients had epithelial skin cancers, and 36 had nonskin cancers or melanoma. No correlations could be established between disease course and type of immunosuppressive agent, type of disease for which transplantation was required, or type of renal allograft donor. The skin cancers demonstrated a propensity for multifocality: 22 of the 44 patients had multiple separate lesions develop. Of the patients with cancer not of the skin, six were treated surgically for carcinoma in situ, and none have experienced disease recurrence. Of 11 patients treated for early invasive disease, 6 are disease‐free, 3 died of intercurrent disease, and 2 died of progressive disease 11 and 13 months, respectively, after disease diagnosis. Nineteen patients had advanced disease, and only 1 is alive and disease‐free. Sixteen died of progressive disease at a median of 1 month from the time of diagnosis, and 2 died of intercurrent disease within 1 week of diagnosis. Conclusions. The natural history of cancers developing in renal transplant patients often is more aggressive than would be expected in patients who have not undergone transplants. The immunosuppression induced to allow viability of the renal allograft may allow tumor cells to thrive.

De novo malignancies after liver transplantation: A major cause of late death

“…A tendency toward aggressive behavior has been noted in malignancies in renal transplant recipients. 87 Although instances of tumor regression with cessation or reduction in the immunosuppressant regimen have been noted in PTLD, 47 most nonlymphoid de novo nonskin cancers follow a virulent course unchecked by return to normal immune surveillance.…”

IL-12 Gene Therapy Is an Effective Therapeutic Strategy for Hepatocellular Carcinoma in Immunosuppressed Mice

“…The management for the prevention of organ rejection requires the use of immunosuppressive therapy during the postoperative periods. However, it is a serious problem that immunosuppressants increase the incidence of skin cancer and sarcoma and induce cancer progression causing incremental fatality of transplant recipients (1-3), because malignant tumors in transplant recipients are frequently more aggressive than similar malignancy in the general population (4). In the field of liver transplantation, it has been accepted that liver transplantation is an effective treatment for small, unresectable hepatocellular carcinoma (HCC) 3 in patients with cirrhosis (5) and it was recently reported that a significant proportion of patients with HCC measuring 5 cm or larger can achieve long-term survival after liver transplantation in the context of multimodal adjuvant therapy (6).…”

Post-transplant acute myeloid leukemia (PT-AML)

“…[4][5][6] AML following solid organ transplantation is less frequent. 7,8 Several cases with AML post-renal transplantation have been published. 7,[9][10][11][12][13][14][15][16][17][18][19] One patient with AML out of a series of 124 cardiac allograft recipients has been reported.…”