Cancer after transplantation.

Abstract

AbstractCancer occurs in immunosuppressed transplant recipients when organs are transplanted from donors dying of cancer. Cancer also occurs spontaneously in transplant recipients with an overall frequency 4 times that of the age‐matched general population. In patients treated with azathioprine and steroids, 14% of those who survive for 15 years after the transplant will have cancer other than skin cancer and, in areas “high risk” for skin cancer, 44% will have malignant lesions of the skin. With non‐skin malignancies, 40% have an association, perhaps causal, with viral infections. These include cancers of the reticuloendothelial system, leukemia, hepatoma, and cancers of the lips, vulva, cervix, and anus. Of these, most are reticuloendothelial malignancies which comprise 30% of all non‐skin cancers. Within this group reticulum cell sarcomas predominate, often with involvement of the central nervous system. The most common malignancies are cancers of the skin. Squamous cell carcinoma is the most frequent lesion and these cancers tend to be multiple, aggressive, and recurrent. Significant numbers metastasize and some patients die of squamous cell carcinoma. Malignant melanoma is also occurring with increased frequency. Malignancies occur virtually from the time of transplantation with an increased risk of developing malignancy continuing indefinitely. Average time for appearance of all cancers is 4–5 years after transplantation. Patients with malignancy treated before transplantation are at increased risk of developing malignancy after transplantation. Clinicians must have a high index of suspicion with regard to cancer development in immunosuppressed transplant recipients. Many such cancers can be cured if diagnosed early and treated effectively. Otherwise, prognosis is poor since cancers that develop in these patients are aggressive.