ABSTRACT
Objectives:
Kidney transplant recipients are at increased risk of malignancy compared to the general population. The prognosis of posttransplant malignancy is poor, and data on how to manage immunosuppression are scarce. This study aimed to evaluate posttransplant malignancy incidence and its effects on graft and patient survival in kidney transplant recipients.
Materials and Methods:
Six hundred and twenty-eight patients who underwent kidney transplantation between 2000 and 2019 were retrospectively examined. Demographic data, transplant and cancer characteristics, graft and patient survival of 33 patients (5.26%) diagnosed posttransplant malignancy were evaluated.
Results:
The average age at malignancy diagnosis was 48 years. Malignancy distribution was as follows: solid organ tumors (57.6%), non-melanoma skin cancers (24.2%) and posttransplant lymphoproliferative disease (18.2%). The time from transplantation to malignancy diagnosis was 66 months. Immunosuppression was reduced in 45.5% of the patients and 54.5% had switched to mammalian target of rapamycin inhibitors. In posttransplant lymphoproliferative disease, all patients received chemotherapy and immunosuppression was reduced in 83.3%. These rates were significantly lower in other malignancies (p=0.010 and p=0.032, respectively). Graft loss was observed in 4 patients (12.1%) and death was observed in 13 patients (39.4%). Immunosupression reduction was not associated with graft survival. Posttransplant lymphoproliferative disease had higher mortality (p=0.049) and shorter patient survival (p=0.006) compared with others.
Conclusion:
Cancer is an important cause of mortality in kidney transplant recipients. We showed that patient survival in posttransplant lymphoproliferative disease is lower than other malignancies. It is important for patients to undergo regular cancer screening appropriate to their age and other risk factors after transplantation. Randomized controlled studies are needed for the management of immunosuppressive treatments.
Keywords:
Kidney transplantation, malignancy, survival
References
1Au E, Wong G, Chapman JR. Cancer in kidney transplant recipients. Nat Rev Nephrol. 2018;14:508-520.
2Kumru G. Böbrek Nakli ve Kanser. Güngör Ö, Koçyiğit İ, Temiz G, editörler. Onko-Nefroloji. Ankara: Nobel Tıp Kitabevi. 2023; s.127-137.
3Webster AC, Craig JC, Simpson JM, et al. Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15,183 recipients. Am J Transplant. 2007;7:2140-2151.
4Wong G, Turner RM, Chapman JR, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation. 2013;95:114-121.
5Acuna SA, Huang JW, Daly C, et al. Outcomes of Solid Organ Transplant Recipients With Preexisting Malignancies in Remission: A Systematic Review and Meta-Analysis. Transplantation. 2017;101:471-481.
6Sprangers B, Nair V, Launay-Vacher V, et al. Risk factors associated with post-kidney transplant malignancies: an article from the Cancer-Kidney International Network. Clin Kidney J. 2018;11:315-329.
7Piselli P, Serraino D, Segoloni GP, et al. Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009. Eur J Cancer. 2013;49:336-344
8Benoni H, Eloranta S, Dahle DO, et al. Relative and absolute cancer risks among Nordic kidney transplant recipients-a population-based study. Transpl Int. 2020;33:1700-1710.
9Al-Adra D, Al-Qaoud T, Fowler K, et al. De NovoMalignancies after Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17:434-443.
10Vogelzang JL, Van Stralen KJ, Noordzij M, et al. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2015;30:1028-1037.
11D’Arcy ME, Coghill AE, Lynch CF, et al. Survival after a cancer diagnosis among solid organ transplant recipients in the United States. Cancer. 2019;125:933-942.
12Güngör M, Kumru G, Eren Sadioğlu R, et al. Relationship Between Posttransplant Proteinuria and Renal Graft Outcomes: A Single Center Experience. 17. BANTAO Congress; 10-13 November, 2022; Antalya, Turkey. s. 30. OP-27.
13Au EH, Chapman JR, Craig JC, et al. Overall and Site-Specific Cancer Mortality in Patients on Dialysis and after Kidney Transplant. J Am Soc Nephrol. 2019;30:471-480.
14Yang D, Thamcharoen N, Cardarelli F. Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy. J Clin Med. 2019;8:2189.
15Hellemans R, Pengel LHM, Choquet S, et al. Managing immunosuppressive therapy in potentially cured post-kidney transplant cancer (excluding non-melanoma skin cancer): an overview of the available evidence and guidance for shared decision-making. Transpl Int. 2021;34:1789-1800.
16Knoll GA, Kokolo MB, Mallick R, et al. Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data. BMJ. 2014;349:g6679.
17Yanik EL, Siddiqui K, Engels EA. Sirolimus effects on cancer incidence after kidney transplantation: a meta-analysis. Cancer Med. 2015;4:1448-1459.
18Opelz G, Unterrainer C, Süsal C, et al. Immunosuppression with mammalian target of rapamycin inhibitor and incidence of post-transplant cancer in kidney transplant recipients. Nephrol Dial Transplant. 2016;31:1360-1367.
19Romagnoli J, Tagliaferri L, Acampora A, et al. Management of the kidney transplant patient with Cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev (Orlando). 2021;35:100636.