Pretransplant Malignancies Research Articles

Outcomes of liver transplant recipients with pretransplant malignancies: Insights from a single institution’s experience.

11173 Background: Increasing liver transplantation (LT) utilization has resulted in more and more patients with a history of a non-hepatobiliary malignancy. Rather than deny such patients a lifesaving therapy the benefits must be weighed against risk of tumor recurrence and de novo malignancies (DNM) post-LT, especially with the immunosuppression required. While data has been presented on outcomes of pre transplant malignancies (PTM) in kidney and heart transplants, LT data is lacking. Our aim is to characterize rates of recurrence, DNM, and overall survival (OS) post-LT at a single, high volume American center. Methods: This retrospective study at Houston Methodist Hospital included patients who underwent LT with known history of PTM. Data was extracted from electronic health records, and descriptive statistics performed. Institutional IRB approval is obtained. Results: Between 01/1999- 12/2022, 1617 LTs were performed at our institute. We identified 261 LT recipients with 297 PTM, including 91 non- and 206 hepatobiliary cancers (See Table). Follow-up period ranged from 1 to 23 years. Post-LT malignancies were observed in 66 patients, 25% of the study population. Tumor recurrences accounted for 44 (17%) cases, and DNM were seen in 22 (8%). The DNMs included skin non-melanoma (n=8 cases), head & neck (3), PTLD (2), prostate (2), renal (1), lung (1), CRC (1), pancreatic (1), gynecologic (2), and poorly differentiated (1). The OS rate at 1-, 5-years (excluding those less than 5 years follow-up and unknown), and at time of last follow-up were 86.6%, 60-65% and 70%, respectively. Patients with post-LT malignancies had lower OS compared to those without (46% vs. 77.7%). Conclusions: To our knowledge, this study is the first to assess post-LT outcomes in patients with PTM. This study of LT recipients with PTM demonstrates post-LT malignancy rates of 25%, including 17% with recurrences and 8% with DNM. The latter is within the previously reported range of 3-14% DNM in the general post-LT population and dominated by skin cancers. Post-LT OS is excellent in these recipients and comparable to all LT patients. However, OS is lower in those with post-LT malignancies, implying a possible role for increased cancer surveillance. Limitations include retrospective design and potential chart bias. Future work in this cohort will focus on immunosuppression effects for this high-risk population. [Table: see text]

Malignancies in adult kidney transplant candidates and recipients: current status.

Posttransplant malignancies, particularly recurrent and de novo, in solid organs including kidney transplant recipients (KTRs) are a significant complication associated with substantial mortality, largely attributed to the long-term immunosuppression necessary to maintain allograft tolerance. Older age at transplantation and oncogenic virus infection along with pretransplant malignancies are among the main factors contributing to the risk of cancer in this population. As the mean age of transplant candidates rises, the rate of transplant recipients with pretransplant malignancies also increases. The eligibility criteria for transplantation in patients with prior cancer have recently changed. The overall risk of posttransplant malignancies is at least double after transplantation, including KTRs, relative to the general population, and is most pronounced for skin cancers associated with UV radiation and virally mediated tumors. The risk of renal cell carcinoma is specifically increased in the kidney transplant population. The therapy for cancer in transplant patients is associated with risk of higher toxicity, and graft rejection and/or impairment, which poses a unique challenge in its management. Reduction of immunosuppression and the use of mammalian target of rapamycin inhibitors are common after cancer diagnosis, although optimal immunosuppression for transplant recipients with cancer remains undefined. Suboptimal cancer treatment contributing to a worse prognosis has been reported for malignancies in this population. In this article, we focus on the prevalence and outcomes of posttransplant malignancies, cancer therapy including a short overview of immunotherapy, cancer screening and prevention strategies, and immunosuppression as a cancer risk factor. The 2020/2021 recommendations of the Kidney Disease: Improving Global Outcomes and the American Society of Transplantation for transplant candidates with a history of cancer are presented.

Pre-transplant malignancy is associated with increased risk of de novo malignancy post-lung transplantation

BackgroundAt least 20% of lung transplant recipients will be diagnosed with a malignancy within 5 years of transplant. Transplant candidates with a history of pre-transplant malignancy must meet remission criteria before listing to minimize the risk of recurrence, however these patients may have an intrinsic predisposition to developing subsequent cancers which can be amplified by immunosuppression. We assessed whether pre-transplant malignancy was associated with an increased risk of developing malignancy of any type after lung transplant. MethodsWe conducted a single centre retrospective cohort study of patients undergoing lung transplant between January 2006 and December 2017. We used a proportional hazards regression model to test whether preTM was associated with the risk of developing one or more postTM after lung transplant, adjusted for known cancer risk factors. Results497 adult patients underwent lung transplantation during the study period and 26 (5.2%) had pre-transplant malignancies. Out of 29 pre-transplant cancer diagnoses, prostate cancer was the most common (17.2%), followed by breast cancer and basal cell carcinoma (13.8% each). 108 (22%) patients developed post-transplant malignancy with a total of 328 cancer diagnoses. The most common post-transplant malignancy was non-melanoma skin cancer (86.3%), followed by solid organ cancers (7.6%). Pre-transplant malignancy was associated with an adjusted HR of 3.24 (95% CI 1.71 to 6.14, p < 0.001) for the development of post-transplant malignancy. Recurrence of the pre-transplant malignancy only occurred in 3 patients post-transplant. ConclusionsHistory of pre-transplant malignancy was associated with a more than three times likelihood of development of a post-transplant malignancy compared to recipients without a previous history of cancer, the majority being unrelated to the initial malignancy. These findings highlight the importance of frequent cancer surveillance in lung transplant recipients, especially in those with a history of pre-transplant malignancy.

STAGE III ADENOCARCINOMA IN THE PNEUMONECTOMY SPECIMEN AT TIME OF LUNG TRANSPLANT RESULTING IN POSTTRANSPLANT METASTASIS DESPITE EXPLANTATION

TOPIC: Transplantation TYPE: Fellow Case Reports INTRODUCTION: Only a few reports have detailed the discovery of non-small cell lung adenocarcinoma in the explanted lung at the time of lung transplant (1). Herein, we present the case of a lung adenocarcinoma, identified in the pneumonectomy specimen, determined to have metastasized in the post-transplant period. CASE PRESENTATION: We reviewed the case of a 61-year-old Caucasian male bilateral lung transplant recipient secondary to end-stage pulmonary fibrosis and pulmonary hypertension. Evaluation of the right lung pneumonectomy specimen revealed multiple foci of lung adenocarcinoma in the right upper, middle, and lower lobes (Figure A – pre-transplant; Figure B – post-transplant). DISCUSSION: Final histopathological evaluation confirmed non-resectable lung adenocarcinoma, pT4N2M0, stage IIIB. The patient was not an ideal candidate for adjuvant radiotherapy due to post-transplant anastomosis site healing. He was also not an ideal candidate for immune checkpoint inhibitors due to insufficient evidence for safety in the solid organ transplant setting. His immunosuppression was reduced, and treatment with adjuvant chemotherapy (pemetrexed/cisplatin) was initiated. The patient suffered complications including pancytopenia and acute renal failure, although his allograft function remained stable through 6 months post-transplant. De novo-donor specific antibodies to DQA1 (20,000 MFI) were detected in sera at 6 months post-transplant, requiring plasmapheresis. At 9 months post-transplant, surveillance bronchoscopy with transbronchial biopsy to evaluate for cellular rejection revealed lung adenocarcinoma associated with lymphangitic carcinomatosis. Follow-up imaging with positron emission tomography and magnetic resonance imaging showed brain, bone, and adrenal gland metastasis. The patient is currently receiving palliative-intent chemotherapy and suffering ongoing pancytopenia and myelosuppression. CONCLUSIONS: Pre-transplant malignancies can remain unidentified due to architectural distortion of the lung parenchyma, even despite appropriately timed, aggressive radiographic surveillance. These malignancies portend worse post-transplant outcomes. REFERENCE #1: Choi YJ, Kim SY, Park MS, Lee JG, Paik HC, Lee SH. Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival. Yonsei Med J. 2020 Nov;61(11):958-964. doi: 10.3349/ymj.2020.61.11.958. PMID: 33107239; PMCID: PMC7593106. DISCLOSURES: No relevant relationships by Hesham Abdelrazek, source=Web Response No relevant relationships by Ashwini Arjuna, source=Web Response No relevant relationships by Michael Olson, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Grifols Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Shire Please note: $1001 - $5000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Astellas Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria

Clinical Characteristics and Outcomes of Cancer Survivors Undergoing Heart Transplantation

<h3>Purpose</h3> Heart transplantation (HT) remains the gold standard treatment for advanced heart failure (HF). Cancer survivors (CS) are at increased risk of developing HF in general and in some cases advanced HF. New consensus statements for organ transplantation in CS support the utilization of HT amongst select CS . The aim of this study was to examine clinical characteristics and outcomes of CS undergoing HT. <h3>Methods</h3> Retrospective cohort study of patients undergoing HT at a large medical center between Jan 1, 2010 and October 2020. CS were defined as those with history of malignancy other than non-melanoma skin cancer (CA) prior to HT. Baseline demographics, CA history and survival data were obtained from electronic medical records. <h3>Results</h3> 57(10.2%) CS were identified out of total of 560 HT recipients during the study period. Median age at the time of transplantation was 60 (IQR 50-65) years, and 60% of patients were male. Common pre-transplant malignancies included 13 breast CA (22.8%), 13 leukemia/lymphoma (22.8%), 8 prostate CA (14%), and 4 testicular CA (7%). 24 CS (42.1%) had received previous anthracycline therapy, and 23 CS (40.4%) had received chest radiation. Median follow-up time post-transplantation was 3.2 years (IQR 1.6-6.9 years). At the end of the study period, 50 of 57 (87.7%) CS were alive. Causes of deaths included infection (n=4), recurrent CA (n=2), and primary graft failure (n=1). Overall 9 patients (15.8%) developed 10 malignancies post HT. 4 patients had recurrence of their prior CA (2 breast ,1 colon, 1 prostate), while 6 patients developed new primary CA (prostate, renal, thyroid, lung, melanoma, lymphoma). The Kaplan Meier 5 year CA free survival was 69.8%(CI 49.8-83.1) (Figure 1) <h3>Conclusion</h3> CS appear to be at high risk of CA recurrence after HT; however infection is the leading cause of death on short term follow up. Longer follow-up is needed to understand long-term outcomes in this heterogenous group of patients to guide listing criteria, immunosuppression and CA screening.

Incidence and Outcome of Post-Transplant Cancer in Kidney Recipients with or without Pre-Transplant Malignancies

Background: Previously, pre-existing cancers were considered a contraindication for kidney transplantation. Meanwhile, due to improved screening and treatment options, the prevalence of dialysis patients with cancer history is increasing. Potentially these patients could be eligible for kidney transplantation.

All-cause and cancer-specific overall survival in kidney transplant recipients with pre-transplant malignancies in a German cohort

Kidney insufficiency and immunosuppression are well established contributors of tumor development, both before and after kidney transplantation. Patients with pre-transplant malignancies (PTM) are at risk of tumor recurrence and of the development of an unrelated tumor after transplantation. In this retrospective study of a German patient cohort, we analyzed 1089 patients that underwent kidney transplantation to determine the frequency, recurrence rate and overall survival of patients with pre-existing tumors across a 10-year period. PTM were found in 5.79% of the patients and appeared at a mean time of 7.39 (SD 6.8) years before transplantation. The tumors were most frequently of urologic (41.43%) origin, followed by malignancies of the skin (25.71%) and gynecologic tumors (10%). Tumor recurrence was observed in one case (1.6%) where the patient died of metastatic spinocellular carcinoma. Patients with pre-existing malignancies had a statistically significantly worse overall survival compared to transplant recipients without tumors (HR = 2.71, 95% CI 1.49–4.969). However, these differences could be entirely ascribed to the age (HR = 1.06, 95% CI 1.04–1.08) and gender (HR = 1.67, 95% CI 1.11–2.52) of the patients. We found that there was no difference in cancer-specific mortality or posttransplant cancer rate between patients with and without pre-existing malignancies (HR = 0.94, 95% CI 0.21–4.26).

Cross-sectional analysis of immunosuppressive regimens focused on everolimus after liver transplantation in a Korean high-volume transplantation center.

BackgroundThe mammalian target of the rapamycin inhibitor has dual inhibitory effects on cell growth and angiogenesis. This study aimed to analyze the usage of everolimus on actual immunosuppression (IS) regimens through a cross-sectional study in a high-volume liver transplantation (LT) center.MethodsOur institutional LT database was searched for adult patients who underwent primary LT surgery between January 2010 and December 2016. We identified 2,093 LT recipients with observation periods of 1 to 8 years.ResultsWe divided the 2,093 recipients into three groups according to the posttransplant follow-up period as follows: group A (12–36 months; n=680), group B (37–60 months; n=560), and group C (>60 months; n=853). The individual IS agents were tacrolimus in 1,807 patients (86.3%), cyclosporine in 169 patients (8.1%), mycophenolate mofetil (MMF) in 1,310 patients (62.6%), and everolimus in 115 patients (5.5%). The most common IS regimens were tacrolimus-MMF combination and tacrolimus monotherapy, regardless of the posttransplant period. Patients with pretransplant malignancies were administered everolimus more frequently than those without pretransplant malignancies (P<0.001). In 102 patients with hepatocellular carcinoma recurrence or de novo malignancies, IS regimens included everolimus-tacrolimus in 41 patients (40.2%), tacrolimus-MMF in 27 patients (26.4%), tacrolimus in 20 patients (19.6%), MMF in 10 patients (9.8%), cyclosporine in three patients (2.9%), and cyclosporine-MMF in one patient (1.0%).ConclusionsAdministration of everolimus after LT has been gradually increasing with the expansion of indications in our institutional practice. Currently, the role of everolimus is minimal and not comparable to that of tacrolimus, but it has a unique position in the field of IS after LT.

Solid Organ Transplantation in Patients With Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study.

Solid-organ transplant recipients with pretransplant malignancies (PTM) have worse overall survival (OS) compared to recipients without history of malignancy. However, it is unknown whether the increased risk of mortality is due to recurrent cancer-related deaths. All solid-organ transplant recipients in Ontario between 1991 and 2010 were identified and matched 1:2 to recipients without PTM using a propensity score. OS was compared using the Kaplan-Meier estimator and Cox proportional hazard models. For cancer-specific mortality and cancer recurrence, cause-specific hazard models were used and the cumulative incidence was plotted. Recipients with PTM had a worse OS compared with recipients without PTM (median OS, 10.3 years vs 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (cause-specific hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.86) but also at increased risk of noncancer death (cause-specific hazard ratio, 1.29; 95% CI, 1.08-1.54). Compared with recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (hazard ratio, 1.81; 95% CI, 1.47-2.23). Recipients with low-risk PTM were not at increased risk (hazard ratio, 1.06; 95% CI, 0.86-1.31). Recipients with PTM are at increased risk of all-cause mortality compared to recipients without PTM. This increased risk was noted for both cancer-specific and noncancer mortality. However, only those with high-risk PTM had worse outcomes.

Analysis of the Incidence and Site of Post-Transplant Cancer in Patients with Pre-Transplant Malignancies

Collaborative Transplant Study. Introduction Patients with a pre-transplant (pre Tx) malignancy were reported to be at an increased risk of developing cancer after kidney transplantation. However, the preferred location of such malignancies was not addressed. Using the CTS database we analyzed the incidence and site of post-transplant (post Tx) malignancies that occurred in patients with different types of pre Tx cancer. Materials and Methods Recipients of first kidney-only transplantations performed between 1984 and 2015 were analyzed for 10-year cancer occurrence. Cancers diagnosed on the day of transplantation were excluded. Using multivariable Cox-regression, the hazard ratio (HR) of post Tx cancer was calculated for 3,948 patients with different types of pre Tx cancer as compared to 263,142 patients without pre Tx cancer (Table 1). Results The location and HR of post Tx cancer in patients with pre Tx genital, urinary, lymphoma or non-melanoma skin cancer (NMCS) are shown in Table 2. All other cancers were merged in the heterogeneous ‘other solid’ category. A strong tendency was observed for the occurrence of post Tx cancer at the pre Tx location. The highest evidence was observed with HR 5.63 for urinary tract cancer in patients with a pre Tx cancer at the same site (P<0.001). Discussion As shown in Table 2, several cancer sites appeared to be linked to each other, e.g. an increased risk of genital cancer was observed also in patients with a pre Tx cancer of the urinary tract (HR=1.69, P=0.015). A dissemination trend was observed in patients with pre Tx lymphomas; due to insufficient case numbers, statistical significance was reached only for the group combining all post Tx cancers without NMSC (HR=2.46, P<0.001). Conclusion Patients with a pre Tx cancer history should be checked regularly for the development of a malignancy after transplantation, especially at the site of the pre Tx cancer. In patients with pre Tx lymphoma, post Tx cancers at various locations are common.

Outcomes of Heart Transplant Recipients With Preexisting Malignancies

BackgroundEnsuring careful selection of heart transplant recipients with pretransplant malignancies (PTM) has been suggested in several retrospective studies. However, cancer survival rates continue to increase and we still lack outcomes data on PTM patients who have undergone heart transplantation (HT) within the Asian region. Herein we report pretransplant characteristics and outcomes among PTM patients with HT. MethodsA total of 354 patients underwent HT from January 2004 to January 2016. Eight of these patients had a history malignancy that was being treated before transplantation. Posttransplant outcomes and clinical characteristics were collected and possible prognostic factors analyzed. ResultsThe median age of the patients with a preexisting malignancy was 60 years. The PTM group included 5 males and 3 females, with a median duration of follow-up of 43 months. In this group there were 2 patients with lymphoma after chemotherapy, 1 with colon cancer postoperatively, and 1 was on chemotherapy. In the other 4 patients, nasopharyngeal cancer, thyroid cancer, breast cancer, and endometrial cancer were identified, and each had undergone treatment. Only 1 premalignancy patient, with nasopharyngeal cancer, had disease recurrence. The 5-year overall survival of these patients was 50.0 ± 17.7%, but 5-year survival for those without PTM was 68.7 ± 2.0%. ConclusionPTM was 2.3% in our cohort. PTM is associated with an increased risk of all-cause mortality. Thus, our findings suggest careful consideration when selecting PTM patients for HT.

Increased Risk of Post-Transplant Malignancy and Mortality in Transplant Tourists

Information on post-transplant malignancy and mortality risk in kidney transplant tourists remains controversial and is an important concern. The present study aimed to evaluate the incidence of post-transplant malignancy and mortality risk between tourists and domestic transplant recipients using the claims data from Taiwan's universal health insurance.A retrospective study was performed on 2394 tourists and 1956 domestic recipients. Post-transplant malignancy and mortality were defined from the catastrophic illness patient registry by using the International Classification of Diseases, 9th Revision. Cox proportional hazard regression and Kaplan–Meier curves were used for the analyses.The incidence for post-transplant de novo malignancy in the tourist group was 1.8-fold higher than that of the domestic group (21.8 vs 12.1 per 1000 person-years). The overall cancer recurrence rate was approximately 11%. The top 3 post-transplant malignancies, in decreasing order, were urinary tract, kidney, and liver cancers, regardless of the recipient type. Compared with domestic recipients, there was significant higher mortality risk in transplant tourists (adjusted hazard ratio = 1.2, 95% confidence interval: 1.0–1.5). In addition, those with either pre-transplant or post-transplant malignancies were associated with increased mortality risk.We suggest that a sufficient waiting period for patients with pre-transplant malignancies should be better emphasized to eliminate recurrence, and transplant tourists should be discouraged because of the possibility of higher post-transplant de novo malignancy occurrence and mortality.

The Fate of Renal Recipients with Pretransplant Malignancies

The Fate of Renal Recipients with Pretransplant Malignancies

The Fate of Renal Recipients with Pretransplant Malignancies

The Fate of Renal Recipients with Pretransplant Malignancies

Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies

Concern regarding recurrence of pre-transplant (Tx) malignancy has disqualified patients from Tx. Because this has been poorly studied in lung and heart Tx recipients our aim was to investigate the influence of pre-Tx malignancy on post-Tx recurrence and long-term survival, focusing on pre-operative cancer-free intervals. From our lung and heart Tx programs (1983 to 2011) we retrospectively identified 111 (lung, 37; heart, 74) of 3,830 recipients with 113 pre-Tx malignancies. The patients were divided into 3 groups by pre-Tx cancer-free interval: Group I, <12 months (n = 24); Group II, ≥12 to<60 months (n = 18); and Group III, ≥60 months (n = 71). Mean age at pre-Tx malignancy was 35±18 years. Mean post-Tx follow-up time was 70±63 months (range, 0-278 months), and malignancy recurrence was 63% in Group I, 26% in Group II, and 6% in Group III. Kaplan-Meier analysis of freedom from post-Tx recurrence revealed the following differences among the groups: Group I vs II, p = 0.08; II vs III, p = 0.002; and I vs III, p<0.001. Overall survival (51 deaths) was significantly poorer in Group I than in Groups II and III (p = 0.044). Survival between Groups II and III did not differ significantly (p = 0.93). Cancer-free survival of ≥5 years pre-Tx is associated with the lowest recurrence. However, recurrence is related to the time the patients were cancer-free, as seen in Groups I and II.

167 Follow-Up of Lung and Heart Transplant Recipients with Pre-Transplant Malignancies

on post transplant survival of patients (pts) bridged to transplant. Methods and Materials: 490 pts were implanted with HeartMate II LVAD in the multicenter BTT clinical trial. 416/490 (85%) had TPG data available for analysis. TPG was calculated as the difference between mean pulmonary arterial pressure and pulmonary capillary wedge. Pts were divided into two groups based on the median TPG value. Results: The median TPG of all pts was 10 mmHg. Pts age (50 13 vs. 51 12), sex, co morbidities, renal and hepatic function, and pre-HTX LVAD support times (239 264 days vs. 262 264 days) did not differ between groups. Overall, there were no differences in LVAD outcomes (Recovery, HTX, or ongoing support) for pts below median TPG ( 10 mmHg) and those above median TPG ( 10 mmHg). However, one year post HTX survival for pts with TPG below the median value ( 10 mmHg) was significantly higher (94%) than for those patients with TPG 10 mmHg (82%) (p 0.006). Analysis based on median PVR of 2.69 or upper quartile PVR of 3.8 did not reveal any differences between LVAD outcome of the groups or their post HTX survival. (91% vs 86% p 0.308, and 90% vs 84% p 0.3 respectively). Conclusions: Elevated TPG prior to LVAD implantation rather than high PVR, is associated with worse 1-year survival in HTX recipients. Elevated TPG appears as an important risk factor for post HTX mortality and therefore should be taken into consideration when contemplating heart transplant versus LVAD destination therapy in patients with advanced CHF.

Screening of patients with pretransplant malignancies

Transplantation has evolved as the treatment option of choice for many patients with end-stage disease of the kidney, liver, and heart. During the past decade significant progress has been achieved in the graft and patient survival rates following solid organ transplantation. As a result, an increasing number of older patients are being considered for organ transplantation, and it is thus inevitable that some of these patients will have a history of tumors and treatment for cancer. Moreover, as the cure rates for hematologic and solid tumors improve, several transplant centers have undertaken a policy of extending organ transplantation to patients who had a “cure” of their preexisting malignancy, but have developed organ failure owing to the side effects of the cancer treatment. Malignancy is a well-known complication of solid-organ transplantation. Therefore, questions often arise as to which patients should be considered candidates for transplantation, when transplantation should be performed, and whether immunosuppression affects the growth of residual malignant cells. At the Cincinnati Transplant Tumor Registry (CTTR), data from transplant centers throughout the world have been collected since 1968. Single-center reports and the CTTR experience (which has been widely reported) is reviewed.

Malignant Tumours in Renal Transplant Recipients Receiving Cyclosporin: Survey of 598 First-Kidney Transplantations

We analysed our population of renal transplant recipients treated with cyclosporin (CsA) and prednisolone with respect to clinically evident de novo malignancies. Eighteen of 598 patients (mean age 35.6 (1-73) years receiving their first renal graft between 1 May 1981 and 31 December 1986 developed a malignancy at a mean interval of 33.5 months. Types of malignancy were squamous carcinoma of the skin (1), carcinoma of the tonsils (1), urothelioma (5), renal-cell carcinoma (2), adenocarcinoma of colon and liver (3), metastic adenocarcinoma of the lung (1), teratocarcinoma of the testis (1), breast cancer (1), Hodgkin's lymphoma in the renal allograft (1), carcinoma of the uterus (1), and carcinoma of the prostate (1). Six cases were observed in the age group 40-49 years (3%), but only three in age group 20-29 years, and nine cases in patients older than 50 years. No malignancy emerged in children (age group less than 19 years) and in patients with pretransplant malignancies. Five patients with analgesic abuse (n = 21 of 598 patients) developed malignant urotheliomas. It is concluded that de novo malignancies constitute a heterogeneous group with no obvious risk attributable to CsA treatment. As previously reported there is a special risk of malignant urotheliomas in patients with analgesic nephropathy. The risk in children seems to be low. We did not observe the high incidence of lymphomas and skin cancer reported by other groups.