Cancer and Renal Transplantation

As morbidity and mortality from graft dysfunction and failure after kidney transplantation have declined, transplant-related malignancies have become one of the most significant sources of posttransplant complications. Currently, cancer is a major factor limiting the life expectancy of kidney transplant patients, and cancer management is now a crucial component of their medical care. This paper discusses the incidence of cancer and its most common types after renal transplantation, the etiology of posttransplant malignancy, and prevention and management of cancer in the renal transplant recipient. Clinicians providing care for renal transplant recipients should be familiar with the types of malignancies for which the renal transplant recipient is at risk, keep immunosuppressive therapy to the minimum level that maintains good graft function, judiciously choose immunotherapies based on the most current and rigorous evidence, engage in cancer prevention efforts throughout the transplant course, practice vigilant cancer surveillance after transplantation, and aggressively treat cancers that do arise. (Adv Stud Med. 2007;7(13):411-419) A s morbidity and mortality from graft dysfunction and failure after kidney transplantation have declined, transplant-related malignancies have become one of the most significant sources of posttransplant complications. Currently, cancer is a major factor limiting the life expectancy of kidney transplant recipients, and cancer management is now a crucial component of their medical care. This paper discusses the incidence and most common types of cancer occurring after renal transplantation, the etiology of posttransplant malignancy, and the prevention and management of cancer in renal transplant recipients. INCIDENCE AND TYPES OF CANCER IN RENAL TRANSPLANT RECIPIENTS CANCER INCIDENCE The incidence of de novo malignancies is generally 3 to 4 times higher in renal transplant recipients than in the general population. For specific types of cancers, the excess incidence relative to the general population can be several hundred times greater. The risk of malignancy in renal transplant patients is also higher than in patients on dialysis or patients on transplant waiting lists. The recent incidence of transplant-associated malignancies is increasing, unlike the declining incidence of opportunistic infections, acute rejection, and other complications. Some authors suggest that cancer will soon overcome cardiovascular disease as the main cause of death in transplant recipients. In fact, the recent analysis of the Australia and New Zealand Transplant Registry demonstrates that cancer has exceeded cardiovascular disease as the leading cause of late death after transplant after 2002. The increase in CANCER AND RENAL TRANSPLANTATION