Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study

Privitera, Francesca; Gioco, Rossella; Civit, Alba Ilari; Corona, Daniela; Cremona, Simone; Puzzo, Lidia; Costa, S; Trama, G.; Mauceri, Flavia; Cardella, Aurelio; Sangiorgio, Giuseppe; Nania, Riccardo; Veroux, Massimiliano

doi:10.3390/biomedicines9080937

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…The latest European Society for Medical Oncology (ESMO) guidelines [ 1 ] describes CRC as the most prevalent cancer in Europe, representing 13.6% of all diagnosed cancers, and being the second cause of mortality with 12.2% of all deaths. Privitera et al [ 6 ] report conflicting evidence on the incidence of CRC in KT patients, which seems to be not significantly different from the general population.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case

Dogahe,

Cubilier,

Taghavi

et al. 2023

Case Reports in Nephrology

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Assessing transplant suitability can be a meticulous process, involving multiple investigations and various specialties. This process is well described in the latest KDIGO guidelines. We recently asked ourselves if those guidelines are still relevant to current clinical practice given the rapid evolution of modern medicine, especially in the field of oncology. We present the complicated case of a 60-year-old woman with ESKD (end-stage kidney disease) and a prior history of cancer, with secondary urological complications, to illustrate different interesting considerations for KT (kidney transplant). Our patient was diagnosed with rectal cancer at the age of 46, for which she was treated with surgery and radiotherapy before developing chronic radiation cystitis. This was followed by repeated urinary tract infections and secondary nephrolithiasis, ultimately leading to severe bilateral hydronephrosis and obstructive ESKD. We know that the type of cancer and its characteristics should be evaluated in detail, and we should offer patient-tailored recommendations after a multidisciplinary evaluation. In our case, the prior rectal cancer is not to be feared because curative treatment has been achieved and the patient has been cancer-free for 14 years, knowing that this type of cancer is not at high risk of recurrence after transplantation. The frail urological anatomy, however, represents a bigger challenge. Not only does it complicate the technical feasibility of KT but it also increases the risk of complications and graft failure. It is difficult to clearly determine KT possibility when considering it in such patients. What is clear on the other hand is that such a decision should be taken considering the choice of the patient and the involved physicians. We should also consider the potential benefits and risks of KT in order to make an informed decision.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case

Dogahe,

Cubilier,

Taghavi

et al. 2023

Case Reports in Nephrology

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“…This increased cancer risk in the KTR population is driven mainly by de novo cancers, with CRC being the third most common cause of cancer death after non-Hodgkin’s lymphoma and lung cancer[ 8 ]. CRC in KTRs is reported to have a worse 5-year survival rate than in the general population[ 9 , 10 ], and develops more often at a younger age[ 9 - 11 ]. Even so, our patient was diagnosed with an advanced CRC at the age of 36 years.…”

Section: Discussionmentioning

confidence: 99%

“…A cost–benefit ratio is another issue, as it was shown that eight colonoscopies were needed to identify one case of advanced neoplasia in KTRs cohort older than 50 years[ 16 ]. Although some authors suggested that screening colonoscopy in KTRs should be expanded to include recipients younger than 50 years[ 11 ] or even between the age of 35 and 50 years[ 17 ], such a policy would be cost-ineffective, in contrast to a screening program with fecal hemoglobin testing[ 17 ]. However, the latter measure is characterized by poor sensitivity but reasonable specificity.…”

Section: Discussionmentioning

confidence: 99%

Transplanted kidney loss during colorectal cancer chemotherapy: A case report

Pośpiech¹,

Kolonko²,

Nieszporek³

et al. 2022

WJCC

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BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients (KTRs) is higher than that in the general population. It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease. Colorectal cancer (CRC), frequently diagnosed in an advanced stage, is one of the most common malignancies in this cohort and is associated with poor prognosis. Still, because of the scarcity of data concerning adjuvant chemotherapy in this group, there are no clear guidelines for the specific management of the CRCs in KTRs. We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer. CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation (2005) because of end-stage kidney disease, secondary to chronic glomerular nephritis, and long-term immunosuppression was diagnosed with locally advanced pT 4A N 1B M 0 (clinical stage III) colon adenocarcinoma G2. After right hemicolectomy, the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX-4). The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation of hemodialysis therapy after a few months. Shortly after that, the patient started palliative chemotherapy because of cancer recurrence with intraperitoneal spread. CONCLUSION Initiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft loss driven also by under-immunosuppression.

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Gut mucosa alterations after kidney transplantation: a cross sectional study

Joshi,

Secondulfo,

Caputo

et al. 2024

J Nephrol

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Background Kidney transplant recipients (KTRs) rely on immunosuppressants like mycophenolate to prevent organ rejection. However, mycophenolate often causes intestinal symptoms and inflammation in various organs, including the skin and the colon. While KTRs have an increased risk for skin cancer, the risk of colorectal cancer is not increased. Elucidating the histological alterations in the colon of KTRs and comparing these changes with known skin alterations would help understand how immunosuppressants influence cancer development and progression. Methods Whole slide images from gut biopsies (Non-transplanted subjects n = 35, KTRs n = 49) were analyzed using the ImageJ and R programming environment. A total of 22,035 epithelial cells, 38,870 interstitial cells, 3465 epithelial cell mitoses, and 7477 endothelial cells, each characterized by multiple microscopy parameters, from a total of 1788 glands were analyzed. The large database was subsequently analyzed to verify the changes of inflammatory milieu in KTRs and in cancer. Results KTRs without colon-cancer showed a significantly higher density of interstitial cells in the colon compared to non-transplanted patients. Moreover, the increase in interstitial cell number was accompanied by subtle modifications in the architecture of the colon glands, without altering the epithelial cell density. We could not identify significant structural modifications in cancer samples between KTRs and non-transplanted patients. Conclusions Our findings demonstrate an increased number of resident interstitial cells in the colon of KTRs, as in other patients treated with mycophenolate. These changes are associated with subtle alterations in the architecture of colon glands. Graphical abstract

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Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study

Cited by 4 publications

References 36 publications

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case

Transplanted kidney loss during colorectal cancer chemotherapy: A case report

Gut mucosa alterations after kidney transplantation: a cross sectional study

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