Risk of de novo cancers after transplantation: Results from a cohort of 7217 kidney transplant recipients, Italy 1997–2009

Piselli, Pierluca; Serraino, Diego; Segoloni, Giuseppe; Sandrini, Silvio; Piredda, Gian Benedetto; Scolari, Maria; Rigotti, Paolo; Busnach, G; Messa, Piergiorgio; Donati, D; Schena, Francesco Paolo; Maresca, Maria Cristina; Tisone, Giuseppe; Veroux, Massimiliano; Sparacino, Vito; Pisani, F.; Citterio, Franco

doi:10.1016/j.ejca.2012.09.013

Cited by 163 publications

(141 citation statements)

References 25 publications

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“…In the past few years, several studies using registry data have provided convincing evidence for the increased incidence of certain cancer types in patients receiving RRT (4,(8)(9)(10)(11)(12)(13)(14)(15)(16). However, it remains to be determined whether meta-analysis of these studies and others may provide results that are different from those of previous meta-analyses.…”

Section: Introductionmentioning

confidence: 50%

“…Of these, 39 were excluded, as they comprised 3 duplicate studies, 2 studies not written in English, 1 review, 21 from which the SIR and 95% CI could not be calculated, 10 studies on hospital-based cohorts and 2 on irrelevant topics. Finally, 22 cohort studies contained in 18 studies were included in the present meta-analysis (8)(9)(10)(11)(12)(13)(14)(15)(16)(22)(23)(24)(25)(26)(27)(28)(29)(30). The main characteristics of the studies included are presented in Table I.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

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Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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Abstract. It has been reported that patients receiving renal replacement therapy (RRT), including dialysis and kidney transplantation, tend to have an increased risk of cancer; however, studies on the degree of this risk have remained inconclusive. The present meta-analysis was therefore performed to quantify the cancer risk in patients with RRT. Cohort studies assessing overall cancer risk in RRT patients published before May 29, 2015 were included following systematic searches with of PubMed, EMBASE and the reference lists of the studies retrieved. Random-effects meta-analyses were used to pool standardized incidence rates (SIRs) with 95% confidence intervals (CIs). Heterogeneity tests, sensitivity analyses and publication bias assessment were performed. A total of 18 studies including 22 cohort studies were eventually identified, which comprised a total of 1,528,719 patients. In comparison with the general population, the pooled SIR for patients with dialysis including non-melanoma skin cancer (NMSC), dialysis excluding NMSC, transplantation including NMSC, transplantation excluding NMSC and RRT were 1.40 (95% CI, 1.36-1.45), 1.35 (95% CI, 1.23-1.50), 3.26 (95% CI, 2.29-4.63), 2.08 (95% CI, 1.73-2.50) and 2.01 (95% CI, 1.70-2.38), respectively. The cancer risk was particularly high in subgroups of large sample size trials, female patients, younger patients (age at first dialysis, 0-34 years; age at transplantation, 0-20 years), the first year of RRT and non-Asian transplant patients. A significant association was also found between RRT and the majority of organ-specific cancers. However, neither dialysis nor transplantation was associated with breast, body of uterus, colorectal or prostate cancer. Significant heterogeneity was found regarding the association between RRT and overall cancer as well as the majority of site-specific cancer types. However, this heterogeneity had no substantial influence on the pooled SIR for overall cancer in RRT according to the sensitivity analysis. Compared with the general population, RRT patients have a significantly increased risk of overall cancer and the majority of specific cancer types, particularly Kaposi sarcoma (KS), lip cancer and NMSC in patients subjected to kidney transplantation and cancer of the thyroid gland and kidney as well as myeloma in dialysis patients. Considering the high heterogeneity encountered, further high-quality studies are required.

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Section: Introductionmentioning

confidence: 50%

Section: Description Of Included Studiesmentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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“…Although lifesaving, organ transplantation is associated with an overall three-to fivefold increased risk of malignancies. [1][2][3][4] Most of these cancers are caused by reactivated viruses whose oncogenic potential is suppressed by immunological reactions in healthy individuals, like Epstein-Barr virus-associated B-cell lymphomas, Kaposi's sarcoma, caused by the reactivation of human herpesvirus type 8, and Merkel cell carcinoma of the skin, associated with Merkel cell polyomavirus. [5][6][7][8][9] Of the cancers presenting in organ transplant recipients that have no established infectious etiology, skin cancer is the most frequent form (95%), including squamous and basal cell carcinomas.…”

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confidence: 99%

Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

et al. 2014

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The aim of this study was to determine whether detection of b-HPV gene products, as defined in epidermodysplasia verruciformis skin cancer, could also be observed in lesions from kidney transplant recipients alongside the viral DNA. A total of 111 samples, corresponding to 79 skin lesions abscised from 17 kidney transplant recipients, have been analyzed. The initial PCR analysis demonstrated that b-HPV-DNA was highly present in our tumor series (85%). Using a combination of antibodies raised against the E4 and L1 proteins of the b-genotypes, we were able to visualize productive infection in 4 out of 19 actinic keratoses, and in the pathological borders of 1 out of 14 squamous cell carcinomas and 1 out of 31 basal cell carcinomas. Increased expression of the cellular proliferation marker minichromosome maintenance protein 7 (MCM7), that extended into the upper epithelial layers, was a common feature of all the E4-positive areas, indicating that cells were driven into the cell cycle in areas of productive viral infections. Although the present study does not directly demonstrate a causal role of these viruses, the detection of E4 and L1 positivity in actinic keratosis and the adjacent pathological epithelium of skin cancer, clearly shows that b-HPV are actively replicating in the intraepidermal precursor lesions of kidney transplant recipients and can therefore cooperate with other carcinogenic agents, such as UVB, favoring skin cancer promotion. Modern Pathology (2014) 27, 1101-1115; doi:10.1038/modpathol.2013.240; published online 3 January 2014Keywords: b-HPV; immunosuppression; kidney transplant recipients; skin cancer; viral life cycle Solid organ transplantation is a treatment offered to an increasing number of patients with end-stage organ diseases. Although lifesaving, organ transplantation is associated with an overall three-to fivefold increased risk of malignancies. 1-4 Most of these cancers are caused by reactivated viruses whose oncogenic potential is suppressed by immunological reactions in healthy individuals, like Epstein-Barr virus-associated B-cell lymphomas, Kaposi's sarcoma, caused by the reactivation of human herpesvirus type 8, and Merkel cell carcinoma of the skin, associated with Merkel cell polyomavirus. [5][6][7][8][9] Of the cancers presenting in organ transplant recipients that have no established infectious etiology, skin cancer is the most frequent form (95%), including squamous and basal cell carcinomas. [10][11][12][13] The incidence of skin cancer, the most common cancer in fair-skinned populations, is at least 50-fold higher in organ transplant recipients. 14-16 Large numbers of skin tumors (often more than 10) tend to develop over time in these at-risk subjects, thus

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“…An analysis carried out by Piselli et al concerning a cohort of post-transplant patients in Italy recognised that Kaposi sarcoma, post-transplant lymphoproliferative disease (PTLD) and solid tumours involving lip, salivary glands, kidneys, mesothelioma and testis were the most common type of malignancies [5]. The majority of renal malignancies in transplant patients arise in the native kidneys.…”

Section: Discussionmentioning

confidence: 99%

De novo papillary carcinoma in a renal allograft: the pros and cons of immunosuppression

2015

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We present a case of a multifocal kidney transplant renal cell carcinoma in a 35-year-old lady, presenting 16 years after kidney transplantation, diagnosed during investigation of recurrent urinary tract infections. The patient underwent a graft nephrectomy and subsequently maintained on haemodialysis. She remained disease-free after 4 years of surveillance and thus reactivated on the transplant list. This case reinforces the fact that immunosuppressive therapy has made kidney transplantation possible; however, it is accompanied by a higher incidence of malignancy. It also reinforces the importance of lifelong screening of both native and renal transplant grafts.

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Risk of de novo cancers after transplantation: Results from a cohort of 7217 kidney transplant recipients, Italy 1997–2009

Cited by 163 publications

References 25 publications

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

De novo papillary carcinoma in a renal allograft: the pros and cons of immunosuppression

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