Occurrence of malignancies after kidney transplantation in adults: Slovak multicenter experience

Abstract

Malignancies are one of the three major causes of renal recipient´s death with a functioning graft after cardiovascular diseases and infections. Among the variety of risk factors, including conventional and specific to transplant recipients, the duration of immunosuppressive therapy, the intensity of therapy, and the type of immunosuppressive agent all have an impact on development of post-transplant malignancy. The aim of our retrospective study was to document the incidence, the type of malignancies, the patient/graft survival in the group of kidney transplant recipients in Slovak Republic, and to identify the factors which influenced the outcome. We analyzed the data of 1421 patients who underwent renal transplantation from deceased or living donors in the period from 2007 to 2015 in the Slovak transplant centers. The incidence of malignant tumors was 6%, the malignancy was diagnosed in 85 patients at the age of 54.1 ± 9.8 years, more frequently in men (68.2 %; P < 0.0001). The mean time of malignancy occurrence was 45 months after transplantation. The most frequent malignancies were skin cancers- basal cell carcinoma (BCC) in 17.6%, squamous cell carcinoma (SCC) in 8.2%, and malignant melanoma (MM) in 2.4% of patients, followed by non-skin tumors such as renal cell carcinoma (RCC) in 16.5%, cancer of colon in 12.9%, prostatic cancer in 9.4%, breast cancer in 9.4%, cancer of lung in 7.1%, post-transplant lymphoproliferative disease (PTLD) in 2.4%, cancer of urine bladder in 2.4%, and cancer of sublingual gland in 1.17% of patients. Surgical treatment was used in 40% of patients, chemotherapy in 7.1%, radiotherapy in 2.4%, treatment with biological agents in 15.3%, combined therapy in 29.4% and palliative treatment in 5.9% of patients. 55.3% of patients underwent conversion from other immunosuppressive agents into mTORi at the time of malignancy occurrence. The remission was achieved in 48.2% of patients, 28.2% of patients were in the oncology treatment in the end of the year 2015, and 23.5% of patients died. There was no difference in the kidney function at the time of malignancy occurrence (s-creat 133.7 ± 59.8 µmol/l) and one year later (s-creat 131.1 ± 47.9 µmol/l) (P = 0.7768). The patients after successful treatment more frequently suffered from BCC (P = 0.0140), did not undergo palliative treatment (P = 0.0033), but were more frequently treated surgically (P < 0.0001).

Malignancy in renal transplant recipients

“…In the present study, we found that the overall prevalence of post-transplantation malignancy was 2.5%. The rate in our center is lower than that in other centers [10,11] and was in line with the studies of the People's Republic of China. [12] The risk of developing malignancy after renal transplantation is due to exposure to immunosuppressive drugs in higher doses and longer periods due to acute or chronic rejection, exposure to viruses known to be carcinogenic, and the presence of direct carcinogenic immunosuppressive genes.…”

“…In the study by Zilinska et al, [11] in 1421 patients who underwent renal transplantation, the rate of malignity development was 6%, and the average time of malignity development was 45 months.…”

“…However, similar with other studies, cancer incidence and cancer types were encountered. [5,[9][10][11][12] In our cancer-developing patients, immunosuppressive drugs were carefully reduced after the cancer operation. We observed no deaths caused by malignity.…”

Neurologic complications in kidney transplant recipients

“…The incidence of post-transplant lymphoproliferative disorders has been estimated at less than 2% (with higher rates in the paediatric population) and 27% of cases involve the CNS and meninges [46,95,155]. In a recent report from database of 1421 adult patients who underwent renal transplantation from deceased or living donors in the period from 2007 to 2015 in the Slovak transplant centres, frequency of PTLD was found as 2.4% [240]. Patients undergoing heart-lung or liver-bowel transplantation are at the highest risk (5%) for CNS malignancies, while the risk is lower with liver, cardiac and bone marrow allografts (1-2%), and lowest with kidney transplantation (< 1%) [95].…”

Radiotherapy of prostate cancer in renal transplant recipients: single-center experience

“…According to a recent meta-analysis by Shang et al, the pooled standardized incidence rate for PCa is more frequent than in the general population [2]. A Slovak multi-center analysis of cancer occurrence in renal transplant recipients revealed that PCa ranked sixth, with an incidence of 9.4% [3].…”