Malignancies In Renal Transplant Recipients Research Articles

Donor-derived urologic cancers after renal transplantation: A retrospective non-randomized scientific analysis.

BackgroundMalignancies in the urinary tract and the kidney graft are quite common after kidney transplantation. In some selected cases tumours develop from donor-derived tissue.ObjectivesWe hypothesised that there is a clinical value to investigate donor/recipient origin in urologic malignancies in renal transplant recipients.MethodsIn this retrospective study, including patients transplanted between the years 1969 and 2014 at Uppsala University Hospital, Sweden, 11 patients with malignancies in urinary tract and 4 patients with malignancies in kidney transplants were investigated. Donor/recipient origin of tumour tissue was analysed by polymerase chain reaction (PCR) of human leucocyte antigen (HLA) genotypes or by fluorescence in situ hybridization (FISH analysis) of sex chromosomes. HLA genotype and sex chromosomes of the tumour were compared to the known HLA genotype and sex chromosomes of recipient and donor.ResultsThree of ten cancers in the urinary tract and three of four cancers in the kidney transplants were donor-derived.ConclusionsWe suggest that urologic malignancies in renal transplant recipients can be investigated for transplant origin. In addition to conventional therapy the allograft immune response against these tumours can be valuable to treat donor-derived cancers.

Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience

Introduction and Objective: Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. Methods: All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. Results: A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. Conclusion: A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Level of evidence: Not applicable

Malignancies in renal transplant recipients: A retrospective single-center descriptive study

The risk of malignancy development in kidney transplant recipients (KTRs) is 2-3 times higher than in the general population. This picture, which emerged with chronic immunosuppressive use, has become more prominent in recent years as the ongoing cause of death in this population. This study aims to determine the common features of KTRs with malignancy in follow-up under a single-center experience. Thus, it is to save time by correctly determining our focus points in patient follow-up.
 Methods. The files of 403 patients who underwent kidney transplantation between 2005 and 2020 in our hospital were reviewed retrospectively. The clinical findings at admission were age, gender, primary disease, use of cyclophosphamide before transplant, duration of dialysis, number of human leukocyte antigen mismatch, transplantation time, previous rejection, the existence of associated viral infections, comorbid diseases, used induction therapy, maintenance immunosuppressive therapy, allograft survival, recipient survival, malignancy development time after transplantation, serum creatinine, glomerular filtration rate (GFR) and presence of proteinuria and hematuria. Using these data, we retrospectively analyzed the incidence and types of malignancies in KTRs.
 Results. During the follow-up period, 22cancer cases have been developed. The median age of the patient was 60 years (IQR 45-64.3) and patients were mostly male (77.3%) The median follow-up period was 111.5 months (IQR76.3–128.3). The median duration of dialysis was 54 months (IQR 11.5-78). The etiology of primary kidney disease in most KTRs recipients was unknown. The percentage of patients with mismatch 3 and above 3 was 86.3%. While the majority of patients received anti-thymocyte globulin (86.4 %) as induction therapy, maintenance therapy was mostly tacrolimus + mycophenolate mofetil + prednisolone (86.4 %). The median time from transplantation to the initial malignancy was 17.5 months (IQR 5-61.3). The most common initial malignancy was skin cancer (22.7%), followed by renal cell carcinoma originating from the native kidney (18.2%).
 Conclusion. Renal transplantation is the most favorable renal replacement therapy. Malignancies are now among the important causes of death in KTRs and these patients have a higher risk of developing cancer than the general population. Therefore, screening for cancer at certain intervals, especially in long-term and elderly recipients after transplantation, will positively affect the survival of the patient and functional renal graft.

Urological Cancers and Kidney Transplantation: a Literature Review

The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.

P1649IS BK VIRUS CARCINOGENIC?!

Abstract Background and Aims The role of polyomaviruses (PyV) in malignancy is controversial, this can be demonstrated in three ways; Firstly, hit and run mechanism where polyomaviruses contribute to the early phases of oncogenic progression. The second way, where PyV act as a passenger as polyomaviruses neither necessary nor contribute to the oncogenic progression. The third way, where PyV acts as (bystander) as PyV is not related to the malignancy, but PyV could be detected in the anatomically connected sites or neighbouring cells. BKV has been classified as a possible carcinogenic to humans (2b) as there is sufficient evidence that it is carcinogenic to animals, however, BKV carcinogenicity evaluation to humans was inadequate. There are inconsistent data regarding the contribution of BKV to tumors that occur in both animals and humans. Method Retrospective analyses of 492 consecutive renal transplant recipients in a single-center, 2010-2018. Data Source: prospectively managed electronic patient records. Malignancy data in both control and BKV infected groups were assessed. Results A total of 492 cases were studied, were categorized into 2 groups the BKV infected group (n:73) patients and BKV non-infected group (n: 419) patients, then an assessment of different malignancies in both groups. The BKV infected group had 15 cases out of 73 who had malignancy, while the BKV non-infected group had 28 cases out of 419 totally (Table 1). The association between malignancy in BKV was statistically significant (P-value of 0.038). Moreover, the risk factors involved in the development of malignancy in renal transplant recipients were older age, BK virus infection and maintenance immunosuppression agents (Table 2). Lastly, Logistic regression analysis was used to assess predictors of malignancy among renal transplant recipients. For every one-year increase in age among renal transplant recipients, the odds of having a malignancy increase by 4.6% (p=0.003). Meanwhile, there is a 4 times increase in the odds of having malignancy for recipients who are BK virus-positive vs. those who are BK virus negative (p=0.001). Furthermore, there is a 10 times increase in the odds of having malignancy for recipients who are on sirolimus as a maintenance immunosuppressant vs. those who are on TAC/PRED/MMF (p=0.007). Conclusion Our study highlights the statistically significant correlation between BK virus infection and the development of malignancy in renal transplant recipients. However, statistical correlation doesn`t mean causation which makes the potential oncogenic role of BKV is unclear. Also, there is increased reporting of malignancy in patients infected with BKV. Increased vigilance is required for early detection of malignancy in patients infected with BKV not only the patients who are heavily immunosuppressed.

De Novo Urologic Malignancies in Renal Transplant Recipients

BackgroundImmunosuppressed organ transplant patients have an elevated risk of malignancies. The aim of this study was to determine the incidence of urologic malignancies in renal transplant recipients, as well as to evaluate their monitoring, treatment, and outcomes. MethodsWe conducted a retrospective single-center study of 2897 renal transplants between January 1987 and December 2016. Recipients presenting with de novo urologic malignancies were evaluated. We retrospectively assessed the stage of the disease, treatment performed, and subsequent oncologic outcome. Patients with a history of preexisting cancers were excluded. ResultsSixty-one de novo urologic malignancies were recorded in 58 patients. The overall incidence of urologic malignancies was 2.2%. We identified 29 cases of prostate cancer, 23 of renal cell carcinoma, 6 of transitional cell carcinoma of the bladder, and 1 case of penile carcinoma. No cases of testicular tumors were found. The mean age at tumor diagnosis was 58.7 ± 10.1 years. The median time between renal transplantation and tumor development was 84 months (range, 2–310 months). Fifty-six (96.6%) patients received deceased donor kidneys. The overall survival rate at 5 years after diagnosis of urologic tumor was 82.8%. Tumor-related death was reported in 13.8% of patients. Nineteen (32.8%) patients had graft loss. Of these, 8 patients had no functional graft when the diagnosis of urologic tumor was made. The therapeutic options did not differ from those used in nontransplanted patients. ConclusionsDue to the increased incidence of tumors and possibly worse prognosis, renal transplant recipients should be screened more regularly.

Malignancy in renal transplant recipients

Malignancy in renal transplant recipients

Multiple Primary Malignancies in Renal Transplant Recipients: a Single Centre Retrospective Cohort Study

Background/Aims: Renal transplant recipients are exposed to immunosuppressive treatment which may increase the risk for developing malignancies. Limited data exists concerning the occurrence of multiple primary malignancies (MPM) in renal transplant patients. Methods: All the patients who received a renal allograft at our institution from 1973 to 2017 were included in this investigation. Data from patients with more MPM were obtained from the charts and medical records. Malignancies were categorized as synchronous if the interval between occurrences was less than or equal to 6 months and metachronous if the interval was more than 6 months. Results: Out of the 1884 patients who received a renal allograft, 164 (8.7%) developed a malignant tumor. Twenty-two patients (13.4%; 6 females, 16 males) developed MPM, 7 synchronous (31.8%) and 15 metachronous types (68.2%). The most common initial primary tumors were skin cancers (8) and kidney cancers (3). Furthermore, skin cancers were the most common second primary malignancies (9). Log-rank analysis revealed significantly better survival in the synchronous group (113.3 months) than in the metachronous group (24.6 months) (p=0.04). Conclusion: MPM are more frequent in renal transplant recipients than in the general population. It is associated with a high mortality rate, especially in the metachronous group. An increased awareness and frequent screening tests are necessary when managing this condition.

Malignancy in Renal Transplant Recipients Exposed to Cyclophosphamide Prior to Transplantation for the Treatment of Native Glomerular Disease.

To evaluate the risk of posttransplantation malignancy in renal transplant recipients exposed to pretransplantation cyclophosphamide for the treatment of glomerular nephropathy (GN). Retrospective cohort study. Tertiary academic medical center. Six hundred adult renal transplant recipients were transplanted between 1993 and 2014; 54 patients were exposed to pretransplantation cyclophosphamide for treatment of GN (GN-CYC group), and 546 patients with polycystic kidney disease were not exposed to pretransplantation cyclophosphamide (PKD group). Data were collected retrospectively from electronic medical records. The primary outcome was occurrence of posttransplantation malignancy. During a median follow-up of 5.5 years, 130 patients developed malignancy (incidence rate 3.5 events per 100 person-yrs). Exposure to cyclophosphamide before transplantation was significantly associated with malignancy after transplantation (adjusted hazard ratio [aHR] 2.20, 95% confidence interval [CI] 1.16-4.22, p=0.02), specifically skin cancer (aHR 2.24, 95% CI 1.09-4.60, p=0.03). Malignancy risk in the GN-CYC group was higher in the setting of lymphocyte-depleting induction (alemtuzumab; aHR 4.53, 95% CI 0.99-20.72, p=0.05) compared with basiliximab induction. Incidences of death-censored graft loss and mortality were similar between the GN-CYC and PKD groups. In our observational study, renal transplant recipients exposed to pretransplantation cyclophosphamide appeared to have a higher risk of developing a malignancy compared with unexposed renal transplant recipients. Further investigation into the impact of pretransplantation immunosuppression on malignancy, particularly the compounded effect with lymphocyte-depleting induction, is warranted.

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.

Lung Cancer in Renal Transplant Recipients

Abstract Introduction. Although the incidence of malignancy has increased after solid organ transplantation, data on lung cancer in this group of patients is scarce. The aim of this study was to determine clinical characteristics and outcome of patients who developed lung cancer after renal transplantation. Methods. Among a cohort of 1658 patients who received a transplant at our institution and were followedup between 1973 and 2014, five patients developed lung cancer. We analyzed risk factors, transplantation characteristics, treatment options and survival. Results. Lung cancer was diagnosed in 5 patients (0.3%). Time to diagnosis after the transplant procedure ranged from 26 to 156 months (mean 115 months). All of them had a smoking history. Tumors were classified as IIB (20%), IIIA (40%), and IV (40%). Histological types included adenocarcinoma (80%) and there was one case of sarcomatoid carcinoma (20%). One patient had concomitant thyroid papillary carcinoma. Radiotherapy was applied in 2 patients, 2 underwent chemotherapy (erlotinib and combination of carboplatinum and etopozide in one patient each), and 2 died within one month after the diagnosis from disseminated malignant disease. Patients with stage IIIA survived 14 and 24 months after the diagnosis. The patient with sarcomatoid cancer underwent thoracotomy with a complete resection, lost his graft function and died 7 months after the diagnosis. Conclusion. Lung cancer is relatively rare malignancy in renal transplant recipients, but associated with high mortality. Smoking is a significant risk factor, thus smoking cessation should be promoted among renal transplant recipients, as well as regular screening for lung cancer.

Immunosuppressive therapy in the posttransplant period and skin cancer.

To determine the incidence of malignancies in renal transplant recipients (RTRs) and to analyze the association between the risk of skin cancer and immunosuppressive regiments used in the posttransplant period. A cohort study was performed on 797 RTRs. Standardized morbidity ratio (SMR) was calculated for the most common types of cancer developed in the posttransplant period and different types of immunosuppressive therapy used in the cohort. 192 cases of malignancies were diagnosed in 86 RTRs (10.8%). Nonmelanoma skin cancer (NMSC) was the most frequent type of cancer (SMR = 6.42, p = 0.000), followed by renal cancer (SMR = 5.9, p = 0.000), malignant melanoma (SMR = 2.59, p = 0.080), and prostate cancer (SMR = 1.21, p = 0.593). The risk to develop NMSC was significantly higher in the group where cyclosporine has been used besides tacrolimus, mycophenolatemophetil and steroids as well as in the group treated with the combination without cyclosporine (SMR = 9.62, p = 0.001 and SMR = 5.18, p = 0.000). Furthermore, the risk was significantly higher in RTRs receiving anti-thymocyte globulin within induction therapy (SMR = 4.14, p = 0.000). The preliminary results indicate that the risk of NMSC in RTRs is significantly higher than in the general population and thus emphasize the need to improve preventive strategies in the Czech transplant population.

Transitional cell carcinoma of urinary bladder in renal transplant recipient: A rare case of an aggressive disease

Malignancies in renal transplant recipients (RTRs) usually have an aggressive biological behavior. They are detected at an advanced stage and have a poor survival rate. Post-transplant urinary bladder malignancy is an uncommon occurrence and most of these patients are in their 5th or 6th decade. We report a rare occurrence of bladder cancer in RTR in the 4th decade more than 10 years after renal transplantation with rapid progression and death within 12 weeks of diagnosis.

CD57 expression in CD8 T cells and development of cutaneous squamous cell carcinoma in renal transplant recipients: a prospective cohort study

BackgroundCutaneous squamous cell carcinoma is the most common malignancy in renal transplant recipients and a major cause of morbidity and mortality. Various measures have been proposed to identify recipients at increased risk of developing this cancer to allow targeted intervention. CD57 expression might represent a marker of T-cell exhaustion; we hypothesised that expression could predict development of squamous cell carcinoma in renal transplant recipients, and undertook a prospective cohort study to assess its predictive value. MethodsRenal transplant recipients with and without previous squamous cell carcinoma (matched by race, age, sex, and immunosuppression duration) were recruited at routine clinical follow-up. Peripheral blood lymphocytes were analysed by flow cytometry. Three previously developed risk scores (Harden, Urwin, and Harwood), based on clinical phenotype, were also evaluated. The outcome event was histologically diagnosed squamous cell carcinoma during the study. Ethics approval was granted by local committee. Hazard ratios (HR) were calculated by Cox regression. Findings57 renal transplant recipients with and 53 without previous squamous cell carcinoma were recruited. During a median follow-up of 309 days (IQR 223–409), 20 recipients developed this cancer (including four with a first diagnosis). On univariate analysis increasing age at enrolment, previous squamous cell carcinoma, having the CD57hi phenotype (≥50% of CD8 T cells expressing CD57), and increasing clinical risk score were predictive of cancer development. However, all three clinical risk scores were no longer predictive when adjusted for age. By contrast, transplant recipients displaying CD57hi were at significantly increased risk of future squamous cell carcinoma compared with CD57lo recipients (≤50% of CD8 T cells expressing CD57) (HR 5·0, 95%CI 1·11–22·3; p=0·04); risk remained significant after adjustment for both age (1·1, 1·0–1·1; p=0·04) and history of previous squamous cell carcinoma (3·5, 1·12–11·2; p=0·04). InterpretationOur results show that the CD57hi phenotype is a stronger predictor of squamous cell carcinoma development in long-term, at-risk renal transplant recipients than previously identified clinical phenotypes. This finding could help in the identification of renal transplant recipients at high risk of this cancer, who would benefit from intensive dermatological screening and immunosuppression reduction. FundingWellcome Trust, Oxford University Hospitals Research Services Committee.

De Novo Visceral Malignancies in Renal Transplant Recipients: Single Center Experience of 2119 Renal Transplantations.

De Novo Visceral Malignancies in Renal Transplant Recipients: Single Center Experience of 2119 Renal Transplantations.

Epidemiology of post-transplant malignancy in Chinese renal transplant recipients: a single-center experience and literature review.

This study investigated the incidence and types of post-transplant malignancy in Chinese renal transplant recipients and the risk factors associated with malignancy. Data from 3,462 patients who underwent renal transplantation at Beijing Friendship Hospital were combined with data from 26 previous reports describing malignancy rates in 27,170 Chinese renal transplant recipients. Between 1974 and 2014, 179/3,462 (5.17 %) patients who underwent renal transplantation at our center developed malignancy. The most common site of malignancy was the urinary system, and the most common type was urothelial transitional cell carcinoma. Combined data from our center and previous reports showed malignancy in 671 (2.19 %) Chinese renal transplant recipients. The ten most common malignancies were urothelial transitional cell carcinoma (n = 283), hepatocellular carcinoma (n = 68), gastrointestinal cancer (n = 63), renal cell carcinoma (n = 42), lymphoma (n = 42), lung cancer (n = 28), breast cancer (n = 19), skin cancer (n = 18), Kaposi's sarcoma (n = 12), and cervical cancer (n = 10). The incidence of post-transplant malignancy in renal transplant recipients was lower in China than the reported rates in other countries, and the most common sites of malignancy were the urinary and digestive system. The relative frequency of malignancy sites differed between northern and southern China. Renal transplant recipients on long-term immunosuppressive therapy should receive careful follow-up, including annual or biannual screening for malignancy in high-risk individuals.

De novo malignancies in renal transplant recipients: experience at a single center with 1882 transplant patients over 39 yr

Cancers complicating organ allografts are a major cause of morbidity and mortality after renal transplantation. Different registries have described an overall three to eightfold increase in cancer risk compared with the general population. This retrospective study investigated the incidence and outcome of de novo malignancies following kidney transplantation in a single German kidney transplantation center. Between 1966 and 2005, 1882 patients underwent kidney transplantation at the Erlangen-Nuremberg kidney transplantation center. The incidence and types of post-transplant malignancies were retrospectively analyzed according to the patients' records and the database of the local cancer registry. We identified 257 malignancies in 231 patients, an overall incidence of 13.7%. The mean follow-up time was 9.9 yr (range, 0.4-25.5 yr). The observed incidence data corresponded to a 12.1-fold increase in the overall risk of developing a malignant nonskin tumor compared with the nontransplanted population. Urinary tract malignancies represented the most frequent malignancies among the nonskin tumors (32.1%), followed by gastrointestinal tract (30.7%) and gynecological (14%) cancers. When we considered the duration from renal transplantation to tumor detection and tumor-specific survival, there was no difference between patients treated with or without a cyclosporine A-based regimen. In our study, the overall risk of developing a post-transplant nonskin malignancy was 12.1-fold higher compared with the age-matched general population. Development of solid organ malignancies is one of the most frequent causes of morbidity and mortality in renal transplant recipients; thus, close tumor screening in patients after kidney transplantations is warranted.

Incidence of Post Transplant Malignancies in Renal Transplant Recipients: Single Center Experience

The incidence of malignancy in transplant recipients is known to be higher than that in the general population. However, the types of malignancies vary geographically, and the relative risks for malignancy in transplant recipients are different, compared with that of the general population. We investigated the incidence and characteristics of malignancies after renal transplantation in a single center analysis. A total of 2740 renal recipients who underwent transplantation between June 1990 and Dec 2010 were enrolled in this retrospective study. During the follow-up period, 153 post-transplant malignancies were developed in 148 of 2740 patients. 24 of 148 patients were died from malignancy. The cumulative incidence of cancer at 1, 5, 10, 15, and 20 years was 0.58%, 3.1%, 7.2%, 13.2 %, and 25% respectively. The post-transplant malignancies were detected from 3 to 226 months after transplantation, with a mean duration of 78.1 ± 55.0 months. Post-transplant lymhoproliferative disorder (PTLD) [18 (11.7%)] was the most common malignancy. Risk of Kaposi sarcoma, PTLD, skin cancer, uterine cancer, urologic malignancy, biliary tract cancer, and breast cancer were more than 10-times higher in KT recipients than general population. In conclusion, the incidence of post transplant malignancy increased rapidly with laps of time following transplantation and related with duration of immunosuppressant exposure. A more vigorous cancer surveillance program should be adapted to detect early cancer in early stage especially in long term follow up patients.

Two papillary renal cell carcinomas of different origin following renal transplantation (Case report)

Papillary renal cell carcinoma (PRCC) is a rare malignant tumor entity compared to common clear cell renal carcinoma. In the present study, we report a patient who was diagnosed with PRCC twice and successfully treated each time following renal transplantation. The first PRCC was located in the left native kidney two years following transplantation, and the second PRCC was diagnosed in the allograft 13 years following transplantation. The two tumors were completely removed by surgery in stage I of the disease with sufficient conservation of the allograft function. Notably, the tumors had a different origin as indicated by the microsatellite analysis, which reflects the exceptional course of the case. Risk factors for PRCC were identified in our patient. We concluded that high-risk candidates for malignancies in renal transplant recipients should receive shorter ultrasonic screening intervals, which may facilitate early tumor detection and improve outcome rates.

2275 THE IMPACT OF SCREENING GUIDELINES IN THE PROPORTION AND MORTALITY OF DE NOVO MALIGNANCY IN A SINGLE CENTRE COHORT OF 2016 RENAL TRANSPLANTS

INTRODUCTION AND OBJECTIVES: De novo malignancy in transplant recipients is one of the most common long-term causes of death. It was not before 2000 that the American Society of Transplantation developed for the first time guidelines for oncological screening in renal transplanted patients. The aim of this study is to report, in a single centre cohort of 2016 patients, the relative frequency of de novo cancer and the potential impact on mortality of screening guidelines for malignancy in renal transplant recipients. METHODS: A retrospective analysis of our prospective database of 2016 patients submitted to allograft transplantation between January 1983 and June 2011 was performed to retrieve data of patients developing de novo tumors. Since a systematic screening schedule for transplanted patients was only implemented in our centre in December 2001, we have compared epidemiological and clinical data from pre and post-2002. Mann-Whitney and Pearson’s chi-square tests were used for statistical comparisons of continuous and categorical variables, respectively. RESULTS: Forty-five de novo malignancies in 43 patients were diagnosed before December 2001 (pre-screening) and 94 de novo malignancies in 75 patients from January 2002 till June 2011(postscreening). The median age at diagnosis in the pre and post-screening periods was 52.5 (IQR:39-59) and 57 (IQR:49-62) (p 0.01) years respectively. Twenty and 23 females with de novo malignancy were diagnosed in the pre and post-screening period. Table 1 shows the relative frequency and table 2 the mortality rates according to tumor types. CONCLUSIONS: There is an increase in the relative frequency of the novo cutaneous tumors in the post-screening era, although not statistically significant. There is also a tendency to an overall reduced mortality in the majority of tumors, which may indicate early diagnosis in the post-screening era. The adoption of screening guidelines for cancer in renal transplant recipients is an important strategy in this high risk population.