Old Male Living Renal Transplant Recipients More Likely to Be at Risk for Colorectal Cancer

Abstract

Background The development of posttransplant malignancy is a well-recognized complication of kidney transplantation due to immunosuppressive therapy. The literature on colorectal malignancy in living renal transplant recipients are limited; most of the data have been collected from deceased donor cases. As living kidney donation is now growing, we sought to define the characteristics and pattern of gastrointestinal malignancy among this group. Methods This cross-sectional, multicenter study analyzed the incidence and characteristics of colorectal malignancy among 17 patients with gastrointestinal malignancy after living donor renal transplantation between 1985 and 2009 in Iran. We observed a new-onset, biopsy-proven colorectal malignancy in eight patients of mean age 49.6 ± 10.3 years (range = 27–60) at transplantation time and a mean age of 61.1 ± 8.6 years (range = 53.4–78.6) at cancer diagnosis. Results The cumulative incidence rate of colorectal malignancy of 0.03% was restricted to the male gender (100%), all of whom had functioning grafts. The mean period from transplantation to diagnosis was 99.7 ± 10.4 months (range = 5–284). The majority of the recipients were aged more than 50 years ( n = 5) and the most frequent immunosuppressive drug was azathioprine ( n = 5); none had received antithymocyte globulin/antilymphocyte globulin. It was mostly a late-onset malignancy with 50% of recipients presenting beyond 5 years from transplantation. They were followed for a mean of 9.2 ± 2.4 (range = 6–12) months after cancer diagnosis with three patients having succumbed within 9 months. Conclusion Due to the long latency after transplantation and the poor outcomes of colorectal malignancy these patients require long-term screening tests for early detection and due to their poor outcomes a new therapeutic approach.