Cancer In Transplant Recipients Research Articles

Optimal time to provide skin cancer and photoprotection education to pediatric solid organ transplant recipients

Optimal time to provide skin cancer and photoprotection education to pediatric solid organ transplant recipients

Periocular Skin Cancer in Solid Organ Transplant Recipients

To determine the proportion of solid organ transplant recipients developing periocular nonmelanoma skin cancer and to describe the morbidity of these cancers in transplant recipients. Cohort study. Consecutive patients undergoing solid organ transplantation at the Cleveland Clinic between 1990 and2008. The charts of all patients receiving a solid organ transplant from 1990-2008 evaluated in the dermatology department for a subsequent biopsy-proven head and neck malignancy through April 2015 were reviewed. Patients with a periocular region nonmelanoma skin cancer (NMSC) or a nonperiocular NMSC causing a complication requiring eyelid surgery were included. Charts were reviewed for demographic data; transplant date, type, and source; immunosuppressive agents received at diagnosis; and type of NMSC, number of nonperiocular NMSCs, ophthalmologic findings, and periocular sequelae after the repair. Primary outcome measures included the type, location, final defect size, tumor-node-metastasis classification, presence of perineural invasion, and reconstruction technique(s) used for each periocular NMSC. Secondary outcome measures included the type and treatment of ocular sequelae due to nonperiocular facial NMSC. A total of 3489 patients underwent solid organ transplantation between 1990 and 2008. Of these, 420 patients were evaluated in the dermatology clinic for biopsy-proven NMSC of the head and neck during the study period, and 11 patients (15 malignancies) met inclusion criteria. Nine patients developed 12 periocular malignancies and 3 patients required eyelid surgery for facial malignancies outside the periocular zone. All 11 patients developed a squamous cell carcinoma (14 malignancies), and 1 patient (1 malignancy) also developed a periocular basal cell carcinoma. There was orbital invasion in 4 cases and paranasal and/or cavernous sinus invasion in 3 cases. Two patients underwent exenteration. Seven cases required reconstruction with a free flap or graft. Periocular sequelae included lower eyelid ectropion (6 malignancies), dry eye and/or exposure symptoms (8 malignancies), unilateral vision loss (3 malignancies), and facial nerve paresis (5 malignancies). Squamous cell carcinoma affecting the periocular region represents a risk of solid organ transplantation and may produce significant ocular morbidity, including the need for major eyelid reconstruction, globe loss, and disfiguring surgery.

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data

Objective To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus. Design Systematic review and meta-analysis of individual patient data. Data sources...

71 Patient education in stoma care; Impact of shortened hospital stay

71 Patient education in stoma care; Impact of shortened hospital stay

Effectiveness of Behavioral Interventions for Promoting Sun-Protection and Preventing Skin Cancer in Solid Organ Transplant Recipients: A Systematic Review.

Background and Aim: The incidence of skin cancer is increased in solid organ transplant recipients. We aimed to assess the effectiveness of behavioral interventions for sun-protection and prevention of skin cancer in transplant recipients. Methods: We systematically searched MEDLINE, Embase, CINAHL, and the Cochrane Trials Register to December 2012 to identify randomized and nonrandomized trials that evaluated behavioral interventions to promote sun protection in solid organ transplant recipients. Results: Five studies (n=747 participants) were included. Study outcomes included change in knowledge, sun-protective behaviors, incidence of actinic keratosis and non-melanoma skin cancer (Table 1). Provision of sunscreen reduced the incidence of actinic keratosis, basal cell carcinoma and squamous cell carcinoma. Knowledge of sun protective behaviors was not improved as a result of passive interventions (e.g. pamphlets). Some specific sun-protective behaviors (e.g. sun screen use) were improved compared to standard care. Conclusion: Ready supply of sunscreen appears effective in reducing the incidence of skin cancer related outcomes in solid organ transplant recipients. Active interventions (e.g. counseling, dermatology clinics) rather than passive interventions are promising strategies for improving sun-protective behavior.Table: No Caption available.

Skin cancer in kidney transplant recipients.

Morbidity and mortality due to skin cancer is excessively high in renal transplant recipients compared to the general population. This epidemiologic difference is mainly due to the severe immunosuppression that enhances ultraviolet-induced DNA damage and leads to reactivation of potential oncogenic viruses. The most common skin cancer in transplant recipients is squamous cell carcinoma followed by basal cell carcinoma, while in the general population this ratio is reversed. Melanoma and cutaneous lymphoma are relatively rare although they occur more frequently in transplant patients than in the general population. Notably some tumors, such as Kaposi's sarcoma, are seldom encountered in the general population while they are frequently observed in transplant recipients. Local recurrences and visceral spreading are not so uncommon and pose a major issue for quality of life and overall prognosis of these patients. Timely diagnosis is essential and may be challenging, since the accuracy of clinical diagnosis is modest; thus skin biopsy is an essential tool for appropriate management. In this review, we describe the most common types of skin cancer in renal transplant recipients, with a focus on pathogenic issues that account for the different epidemiology and clinical expression of these neoplasms in this population.

The Cutting Edge of Skin Cancer in Transplant Recipients: Scientific Retreat of International Transplant Skin Cancer Collaborative and Skin Cancer in Organ Transplant Patients Europe

The International Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 300 physicians and scientists focused on the study of dermatologic changes following solid organ transplantation. Transplant patients have a 100-fold increased risk of developing skin cancer. In October 2012, ITSCC and its European counterpart Skin Cancer in Organ Transplant Patients Europe held a joint biennial retreat in Essex, MA to discuss novel findings in the pathogenesis and management of skin cancer in solid organ transplant recipients. This meeting report is a summary of the novel findings discussed.

Risk of bladder cancer in renal transplant recipients: a meta-analysis

Background:Renal transplantation has been associated with a significantly increased risk of developing cancers during long-term follow-up, but for bladder cancer, this risk is less clear. We therefore performed a meta-analysis to determine whether bladder cancer risk in renal transplant recipients was increased.Methods:Eligible studies were identified through searches of PubMed and other public resources. Random-effects meta-analyses were used to pool overall estimates for standardised incidence ratios (SIRs). Heterogeneity test, sensitivity analysis, and assessment of publishing bias were also performed.Results:We identified a 3.18-fold higher SIR (95% confidence intervals (CI): 1.34–7.53, P=0.008) of bladder cancer in patients following renal transplantation compared with the general population, based on data from 79 988 patients with a total follow-up of 308 458 patient-years. When stratified by ethnicity, the SIRs for bladder cancer were 2.00 (95% CI: 1.51–2.65, P=0.001) and 14.74 (95% CI: 3.66–59.35, P<0.001) between European and Asian renal transplant recipients, respectively.Conclusions:Our study demonstrated that the risk of developing bladder cancer in transplant populations was increased. Such association suggests that physicians should be more vigilant in checking for bladder cancer in transplantation recipient population.

Outcomes of Colorectal Cancer Arising in Solid Organ Transplant Recipients

IntroductionThe incidence of colorectal cancer posttransplantation is unclear. Limited reports exist and have conflicting conclusions. We aimed to review the clinical features and oncologic outcomes of colorectal cancer in transplant recipients at our institution. MethodsA retrospective review of all patients diagnosed with colorectal cancer after solid organ transplantation between 2000 and 2011 was conducted. Clinical features and outcomes were reviewed. ResultsTwenty of 3,946 patients were identified. The most common single organ transplanted was the kidney (n = 8). Six patients had multiorgan transplantation. Median age of diagnosis of cancer was 64.3 years, and median time from transplant to diagnosis of cancer was 8.7 years. Ten patients were symptomatic at presentation. Cancer was identified on routine colonoscopy in seven patients. Tumors were most commonly found in the right colon (n = 14, 70 %). Six patients had stage IV disease at presentation. Short-term morbidity was identified in 11 patients. Postoperative mortality occurred in one patient. Median follow-up was 2.47 years. Overall survival at 5 years was 69 %, and disease-free survival was 68 %. Distant recurrence was seen in 3 (15 %) patients. ConclusionColorectal cancer in these patients is rare, and surgery can be done safely. Vigilant screening must be maintained in this patient population.

Cancer in the Transplant Recipient

Malignancy has become one of the three major causes of death after transplantation in the past decade and is thus increasingly important in all organ transplant programs. Death from cardiovascular disease and infection are both decreasing in frequency from a combination of screening, prophylaxis, aggressive risk factor management, and interventional therapies. Cancer, on the other hand, is poorly and expensively screened for; risk factors are mostly elusive and/or hard to impact on except for the use of immunosuppression itself; and finally therapeutic approaches to the transplant recipient with cancer are often nihilistic. This article provides a review of each of the issues as they come to affect transplantation: cancer before wait-listing, cancer transmission from the donor, cancer after transplantation, outcomes of transplant recipients after a diagnosis of cancer, and the role of screening and therapy in reducing the impact of cancer in transplant recipients.

The development of squamous cell carcinoma in a patient after kidney transplantation: a

In patients with organ transplantation as compared to the general population the risk of cancer is significantly increased. The most common changes are malignant tumors of the skin, constituting 30-65% of malignant tumors found in recipients. Potential risk factors for skin cancer after a transplant operation are: solar radiation, immunosuppressive therapy, genetic factors, infection with HPV and skin cancer transmission before transplantation. In contrast to the immunocompetent population, skin cancers in transplant recipients are dominated by squamous cell carcinoma, followed by basal cell carcinoma. Squamous cell carcinoma in patients after transplantation is characterized by a strong tendency to give local recurrences and distant metastases. Due to the high risk of developing skin cancer in transplant recipients, preventive oncology plays an important role in the long-term care of patients after transplantation. This includes: sun protection, education, and early treatment of patients with precancerous lesions. It is also stressed that systematic dermatologic studies need to be carried out in patients after transplantation surgery. The paper contains basic information about skin cancers in organ transplant recipients: epidemiology, potential risk factors, treatment and prognosis. The paper presents also a case of patient who developed squamous cell carcinoma of the skin 3 years after renal transplantation.

Head and neck cancer in transplant recipients

The development of malignancy in organ transplant patients is a well-known complication of long-term immunosuppressive therapy. We sought to characterize our institution's 20-year experience with head and neck cancer after solid organ transplantation. Retrospective review. Patients who underwent a solid organ transplant with subsequent development of a head and neck malignancy, including cutaneous and noncutaneous (upper aerodigestive tract and salivary gland) cancers, from January 1990 through December 2011 were identified. Patients were stratified according to cancer type, location, stage, and survival and compared to a nontransplant cohort in our institution's tumor registry. Of 95 patients identified, 17 had noncutaneous and 78 had cutaneous head and neck malignancies post-transplant. Among the noncutaneous group, no statistically significant differences occurred in age, gender, stage, or 5-year survival status when compared to the nontransplant tumor registry cohort. However, significantly fewer transplant patients were alive at 1 year. Among the cutaneous group, >50% had multiple malignancies. The total incidence of head and neck cancer following organ transplantation was 2.6%. Although the development of head and neck cancer is a rare side effect of immunosuppression, it still warrants attention. These patients have been found to be less likely to survive >1 year when compared to their nontransplant counterparts. Patients who develop head and neck malignancies following organ transplantation require aggressive screening, treatment, and follow-up, as this diagnosis may portend a poor prognosis.

Oral squamous cell carcinoma in a Crohn's disease patient taking azathioprine: Case report and review of the literature

Thiopurines are widely used for remission maintenance and post-operative recurrence prevention in Crohn's disease. The increased risk of cancer in transplant recipients on azathioprine is well recognized and there are concerns that this may also be true for inflammatory bowel disease patients.We report a case of a 33-year-old Caucasian woman with Crohn's disease treated with azathioprine for 9years who developed an ulcerated lesion at the right superior retromolar trigone. Biopsy specimen revealed a squamous cell carcinoma.

Can sirolimus prevent skin cancer in transplant recipients?

Non-melanoma skin cancer occurs at an alarmingly high rate in transplant recipients, causing considerable morbidity and sometimes even mortality. A recent prospective clinical study performed by nephrologists and dermatologists at the Johann Wolfgang Goethe University in Frankfurt suggests that switching renal transplant recipients with skin lesions onto the mTOR inhibitor sirolimus might keep non-melanoma skin cancer in check.

Comparison of the Incidence of Malignancy in Recipients of Different Types of Organ: A UK Registry Audit

An increased incidence of malignancy is an established complication of organ transplantation and the associated immunosuppression. In this study on cancer incidence in solid organ transplant recipients in Britain, we describe the incidence of de novo cancers in the allograft recipient, and compare these incidences following the transplantation of different organs. Data in the UK Transplant Registry held by NHS Blood and Transplant (NHSBT) were linked with data made available by the cancer registries in England, Scotland and Wales. Incidence rates in the transplanted population were then compared with the general population, using standardized incidence ratios matched for age, gender and time period. The 10-year incidence of de novo cancer in transplant recipients is twice that of the general population, with the incidence of nonmelanoma skin cancer being 13 times greater. Nonmelanoma skin cancer, cancer of the lip, posttransplant lymphoproliferative disease and anal cancer have the largest standardized incidence ratios, but the incidence of different types of malignancy differs according to the organ transplanted. Patterns in standardized incidence ratios over time since transplantation are different for different types of transplant recipient, as well as for different malignancies. These results have implications for a national screening program.

Free Sunscreen Prevents Skin Cancer in Transplant Recipients

Free Sunscreen Prevents Skin Cancer in Transplant Recipients

De Novo urinary and male genital cancers in kidney transplant recipients

：Objective To explore theoutcomes of kidney transplant recipients who developed urinary and male genital cancersafter transplantation. Methods Data of 31 kidney transplant recipients developed de novourinary and male genital cancer were compared with data of 31 patients in generalpopulation with the same age and same tumor stage. Results Compared with the generalpopulation, the overall survival was significantly worse in the transplant recipients(P=0. 02) , 5-year survival rates for each group were 50% vs 68%. Multivariate analysesdemonstrated cancer stage to be a negative risk factor for survival for transplantrecipients with de novo urinary and male genital cancer, and surgery and functioning graftto be the positive survival predictors. Conclusions Transplant recipients experience worseoutcomes than the general population from urinary and male genital cancers. Cancers intransplant recipients are more biologically aggressive at the time of diagnosis.

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Malignancy incidence after renal transplantation in children: a 20-year single-centre experience

Cancer is a well-recognized complication of organ transplantation. The pattern of malignancies that occur in the paediatric graft population is different from that in the general paediatric population and in the population of adult organ transplant recipients. We reviewed medical records from 240 consecutive paediatric renal transplantations performed in 219 children, aged less than 19 years, in our centre between April 1987 and March 2007. Data from patients who had been transferred into adult units were extracted from the French registries of dialysis and transplantation. Among the 219 children who underwent renal transplantation during the study period, 16 (7.3%) developed malignancy. The cumulative incidence of cancer was 1.9, 4.0, 6.9 and 10.2% at 1, 5, 10 and 15 years post-transplantation, respectively. The 10-year incidence of post-transplantation lymphoproliferative disorder (PTLD) was 4.5%. Other identified cancers were Hodgkin lymphoma, Burkitt lymphomas, renal papillary carcinoma, thyroid papillary carcinoma, recurrent ovarian seminoma and skin cancer. The mortality rate was 25% (4/16). Early detection of cancer in transplant recipients is of great importance. Regular screening for persistent Epstein-Barr virus (EBV) DNA viral load in patients at risk for developing PTLD is recommended. The occurrence of skin cancer in transplanted children is extremely rare during childhood, but cases can develop in early adulthood.

Fighting Malignancy in Organ Transplant Recipients

The development of malignancy in immunosuppressed organ transplant recipients has recently gained increasing attention. Increased awareness of this problem has come from recent data indicating that vascular disease and cancer are the leading causes of death in transplant recipients. Despite the realization of this fact, few efforts have been made to thwart deaths due to cancer in transplant recipients. However, now that many transplant recipients maintain their organ allografts for decades, the risk for cancer is increasing even more, exposing a need for possible solutions. Fundamentally, transplant recipients are at a high risk for cancer because the immunosuppressive drugs used in their treatment regimen suppress immune reactivity against arising cancer cells. Some of these drugs directly impede DNA repair, induce cancer cell aggressiveness, and promote tumor angiogenesis. In situations where cancer has developed in transplant recipients, one potential action is to reduce their daily immunosuppression. In some cases immunosuppression minimization can reduce tumor growth or even result in tumor regression, but the threat of rejection increases substantially. Another possible solution is to move toward mammalian target of rapamycin (mTOR)-based immunosuppression, use of which has been experimentally demonstrated to have both immunosuppressive and potent anticancer effects. Clinical studies are presently underway to test this idea, which could help to alleviate the problem of cancer in transplant recipients. In this overview, the topic of cancer in transplant recipients will be addressed, as well as new approaches to reduce this increasingly recognized problem in transplantation.