Malignant neoplasms of the skin in recipients after kidney transplant: is the cancellation of immunosuppressive therapy inevitable?

Abstract

Background. With a constant increase in the number of renal transplant recipients and an increase in their life expectancy, the number of complications associated with immunosuppressive therapy is progressively increasing. The incidences of oncological diseases are approximately 100 times higher than the incidence in the general population. Skin neoplasms constitute a significant part of oncological diseases after kidney transplantation.Materials and methods. In our clinic in the period from 2010 to 2017, four patients with malignant neoplasms of the skin were observed. Three of them developed Kaposi’s sarcoma in the period from 6 months to 6 years after kidney transplantation, one was diagnosed with squamous cell skin cancer 10 years after the operation.Results. After histological verification, excision of neoplasms was performed in two cases, followed by a decrease in the dosage of immunosuppressive drugs; in one case, a complete conversion of immunosuppressive therapy was performed. During therapy, stabilization of the condition was noted, however, further deterioration in the function of the graft was noted, which led to the loss of kidney function and removal of the grafts. A patient with basal cell skin cancer underwent surgical treatment with a course X-ray radiation, but further progression led to the death of the patient.Conclusion. Kidney transplant patients are at high risk of developing skin malignancies and death from cancer. Early detection of the disease and complete withdrawal of immunosuppressive drugs – calcineurin inhibitors, despite the high probability of loss of graft function are still often remain necessary conditions for the treatment of patients with skin malignant neoplasms.