Cancer Screening in Solid Organ Transplant Recipients: A Focus on Screening Liver, Lung, and Kidney Recipients for Cancers Related to the Transplanted Organ

Abstract

Over the last few decades, the life expectancy of solid organ transplant recipients (SOTRs) has improved significantly. With SOTRs living longer, more recipients are dying from cancer. There is a reported 2-to 3-fold increased risk of cancer-specific mortality in SOTRs compared with the general population. Cancer in an SOTR can be de novo, recurrent, or donor-derived. Cancer screening in this population is crucial, as early detection and treatment may improve outcomes. In the absence of randomized controlled trials dedicated to SOTRs, clinicians rely on clinical practice guidelines from regional and national transplant societies; however, these may vary considerably across jurisdictions and transplanted organ. At present, no widely accepted consensus exists for cancer screening protocols in SOTRs, particularly with regard to screening for malignancy related to transplanted organ. Some SOTRs may be at higher risk of malignancies within the allograft. This is particularly the case in lung and liver recipients, though less common in kidney recipients who are at increased risk of developing renal cell cancer in their native kidneys. This increased risk has not been uniformly incorporated into screening recommendations for SOTRs. In this review, we summarize the cancer screening recommendations for SOTRs from various transplant organizations based on transplanted organ. This review also discusses the complexity and controversies surrounding screening of cancer in the allograft and future avenues to improve cancer detection in this context. More studies specific to SOTRs are required to form generalizable and evidence-based cancer screening guidelines, particularly with respect to cancer screening in the allograft.

Cancer mortality after kidney transplantation: A multicenter cohort study in Italy

“…Prevention and screening play an important role in reducing the cancer burden in this at‐risk population. Although routine cancer screening is recommended for all individuals undergoing KT, current surveillance strategies are largely based on data from the general population 34 . Recommendations for cancer screening should also be targeted to cancers for which transplant recipients are at high risk and, therefore, individualized based on the risk factors specific to the transplant population 11,12 …”

Lung cancer screening using low-dose CT and FDG-PET in liver transplant recipients

“…In the absence of randomized controlled trials dedicated to this group, the screening guidelines available for implementation in the general population are still under debate. [14] To our knowledge, there are only limited data incorporating a screening flowchart and outcomes for patients who developed lung cancer after liver transplantation. [15,16] The aim of this study is to address the feasibility of implementing a lung cancer screening program in LTR targeted to detect early-stage lung cancer.…”

“…Most of the evidence however is based on the general population data. In the absence of randomized controlled trials dedicated to this group, the screening guidelines available for implementation in the general population are still under debate 14 . To our knowledge, there are only limited data incorporating a screening flowchart and outcomes for patients who developed lung cancer after liver transplantation 15,16 …”

Thermoablative Treatment of De Novo Tumor in Kidney Allograft

“…1 The overall risk of cancer is increased in patients with kidney allograft, and several types of tumors are concerned. [2][3][4] Renal cell carcinoma (RCC) affecting native kidneys appeared to be approximately 15-fold more common than in the general population. 5,6 However, the risk of developing a de novo tumor in the renal allograft is lower than in the native kidneys.…”

“…5,6 However, the risk of developing a de novo tumor in the renal allograft is lower than in the native kidneys. 2,5 The incidence of de novo tumors in renal allografts is very low, ranging from 0.2% to 0.5%. 3,[7][8][9] About 250 cases have been reported in the literature.…”