Gastrointestinal carcinomas in renal transplant recipients

Abstract

The development of malignancies in renal transplant recipients is well documented. Typically, these are cutaneous tumors or lymphomas. During the past 5 years, we have encountered six patients with documented carcinomas of the gastrointestinal tract, which developed after these patients received renal transplants. These carcinomas developed at an average of 10 years (range 2-16 years) after renal transplantation. There were three carcinomas of the colon, and one each of the esophagus, stomach, and anal canal. In many instances, the patients had examinations prior to transplantation which were normal. Several surveys of transplant recipients indicate there is an increased incidence of gastrointestinal tract malignancies after transplantation. These studies also recommend that screening of the gastrointestinal tract in long-term transplant recipients be performed. Since these patients are often imaged in the radiology department, radiologists must be aware of this possible complication.

Gastrointestinal Disorders after Renal Transplantation

“…However, there is 1 report of a 28-year-old white male patient who, in the absence of any possible risk factors but immuno suppression, suffered from an esophageal carcinoma 10 years after renal transplantation [110]. Gastric carcino mas are also relatively infrequent in renal transplant recipients [94,111], Since a prolonged exposure to immu nosuppression may be needed to develop a gastrointesti nal tumor, screening and surveillance may be justified after a time period of about 10 years after transplantation [94. 100], Kaposi's Sarcoma Kaposi's sarcoma has a high frequency in renal trans plant patients and represents about 3% of newly arising cancers in this patient population [5.…”

“…These tumors appear to occur more commonly in women and the affected patients are much younger than persons of the general population with the same malignancies [94,109], Esophageal Carcinomas Esophageal carcinomas are generally rare in renal transplant recipients. In the Cincinnati Transplant Tu mor Registry ( 1968Registry ( -1985 there are reports of 2.435 can cers in 2,278 renal transplant recipients; among these tumors, only 9 were esophageal [110].…”

“…In a review of 478 patients treated with cyclo sporine, the age-and sex-adjusted relative risk of devclopGastrointestinal Disorders after Renal Transplantation ing a neoplasm was 3.08. but 26.9 for lymphoma [95], Compared to the general population, posttransplant lym phoma has several characteristic features, such as a fre quent extranodal involvement in a single organ [96], a sig nificantly higher mortality [96] and, in some cases, a suc cessful therapeutic response to a reduction or discontin uation of immunosuppression and antiviral therapy [96. 97], Antiviral treatment may be performed because of the significant association of posttransplant lymphoproliféra tive disorders with Epstein-Barr virus that has been described in several articles [96][97][98][99], Reports on malignancies affecting the gastrointestinal tract usually describe lymphomas, and rarely carcinomas [94], The gastrointestinal tract represents the most fre quently involved extranodal site in patients treated with cyclosporine [96,97], Compared to carcinomas of the gas trointestinal tract, lymphomas have a shorter latent peri od [100], often only a few months after transplantation [97], However, several case reports describe a great varia tion in the time interval between the diagnosis of the gas trointestinal lymphoma and the transplantation, ranging from 3 months to 18 years [97, 99,[101][102][103][104], Lymphoma may involve different sites in the gastrointestinal tract, such as mesenteric lymph nodes, stomach, small intestine, liver, spleen, and colon [97,99,[101][102][103][104][105][106][107], Gastrointesti nal lymphoma can cause a severe pathology, including abdominal pain, bleeding, obstruction and perforation with oligosymptomatic pneumoperitoneum or overt peri tonitis [97. 101,103,105], Treatment of primary gas trointestinal lymphoma remains controversial.…”

“…1 esophagus. 1 stomach, and 1 anal canal) that occurred at an average of 10 years (2-16 years) after kidney transplantation [94], A con trolled study based on the data from the Swedish Cancer Registry reports a fivefold increase in colorectal cancer [108], ' Dig Surg 1997;14:136-147…”

Rapid progression to high-grade dysplasia in barrett's esophagus after liver transplantation

“…Although esophageal cancer is a common malignancy in the general population, there are only three reported cases after transplantation. [2][3][4] We report a patient with Barrett' s esophagus who developed rapid progression from no dysplasia to high-grade dysplasia 9 months after liver transplantation.…”