Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review

Abstract

Life expectancies for solid organ recipients as well as graft survival rates for these patients have improved over the years because of advanced immunosuppressive therapies; however, with chronic use of these drugs, posttransplant malignancy has become one of the leading causes of morbidity for them. The risk of carcinogenesis in transplant recipients is significantly higher than for the general population and cancers tend to manifest at an advanced stage. Posttransplant malignancies are thought to develop by three mechanisms: de novo development, donor-related transmission, and recurrence of a recipient's pretransplant malignancy. Although nonmelanoma skin cancer, Kaposi sarcoma, posttransplant lymphoproliferative disorder, anogenital cancer, and lung cancer are malignancies that are thought to arise de novo, malignant melanoma and cancers that arise in the renal allograft are frequently donor related. Hepatocellular carcinomas and cholangiocarcinomas have a greater tendency to recur in liver transplant recipients. An altered or deranged immune system caused by chronic immunosuppression is considered to be one of the major contributing factors to carcinogenesis. The proposed pathogenic mechanisms for oncogenesis include impaired immunosurveillance of neoplastic cells, weakened immune activity against oncogenic viruses, and direct carcinogenic effects of immunosuppressive agents. Imaging plays an important role in screening, follow-up, and long-term surveillance in patients with malignancies because key imaging features can guide in their timely diagnosis. However, some benign entities such as transplant-related renal fibrosis, biliary necrosis, and infectious nodules in the lungs mimic malignancies and require pathologic confirmation. Management strategies that can improve malignancy-related morbidity and mortality in transplant recipients include prevention of risk factors, appropriate modulation of immunosuppressive agents, prophylaxis against infection-related malignancies, and use of intensive targeted screening programs. (©)RSNA, 2016.

Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review

“…The renal allograft is susceptible to the same forms of malignancy known to occur in the native kidney, but also carries the additional risk for development of malignancies associated with chronic immunosuppression of the host and unregulated oncogenic viral infections (130). The risk of primary renal malignancy in the allograft overall is about six times that in the native kidney for all types, but substantially higher for papillary subtypes (13 times the general incidence) ( Figs 18, 19) (131).…”

Integrated Proteome and Cytokine Profiles Reveal Ceruloplasmin Eliciting Liver Allograft Tolerance via Antioxidant Cascades

“…Liver allograft transplantation is an ultimate method for treating patients with end-stage liver diseases; nevertheless, nonspecific immunosuppressive drugs elicit severe complications such as increased risk of infection and tumorgenesis ( 2 , 34 , 35 ). Therefore, a major issue in transplantation is inducing and promoting specific immune tolerance while most tries could not successfully been implied into the clinic.…”

Metastatic Lung Adenocarcinoma Harboring an EGFR-Activating Mutation in a Heart Transplant Recipient

“…Recipients of solid organ transplant have an overall two- to three-fold increase in risk of a wide spectrum of malignancies compared with the general population, mainly as a result of the administration of immunosuppressive drugs for a prolonged period and the detrimental impacts on cancer immunosurveillance and potential direct carcinogenic effects. 1 The incidence of post-transplant malignancies is approximately 4% 2 and they account for 10% to 47% of deaths in solid organ recipients. 2 …”