Posttransplant Malignancies in Renal Transplant Recipients: 22-years Experience from a Single Center in Pakistan

Yunus, Mahira; Aziz, Tahir; Mubarak, Muhammed

doi:10.7314/apjcp.2012.13.2.575

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…Reasonably, worse outcome could be predicted for blood transfusion during the peri-operative period in either cancer groups or posttransplantation groups according to their pre-existed immunosusceptibility and medication-associated immunosuppression status. Recently, several studies had proved that incident malignancies, including lymphoma and malignancies in kidney, liver and skin, could develop in the post-transplantation populations (Gu et al, 2012;Li et al, 2012;Yunus et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Tsai

Hsieh²,

Chang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were 11.6±1.8 g/dL and 11.7±1.7 g/dL, respectively; and the nadir Hb level post operation and the final Hb level before discharge were 8.3±1.6 g/dL and 10.2±1.6 g/dL, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

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Section: Discussionmentioning

confidence: 99%

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Tsai

Hsieh²,

Chang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…In contrast to most of the data reported from various regions in India, the present study has incidence of 4.7% that is 2–3 times higher but still less than that reported in transplant registries from other developed countries. [ 22 23 ] Our study's overall low incidence of malignancy could be due to lower age of recipient at time of renal transplant, lower immunosuppression, no use of antithymocyte globulin, except for resistant rejection, missing follow-up data, relatively lower post renal transplant survival, and inadequate follow-up. There is a striking paucity of skin cancer though equally impressive is the presence of tongue cancer and late-onset PTLD with negative EBV status unlike reports from other centers of India and developed countries.…”

Section: Discussionmentioning

confidence: 98%

“…There seems to be some geographical variability in malignancy among renal transplant recipient with most common cancer being reported as skin cancer from Australia, Germany, and Hong Kong, while lymphoma from UK, Sweden, Germany, South Africa, India, and Pakistan. [ 6 16 17 18 22 23 ] Increased incidence of KS from Saudi Arabia and gastrointestinal cancer from Japan has been reported. [ 24 ] However, there is no mention of increased risk of oral cancer involving tongue in any of such reports even from the South Asian region unlike the present study where carcinoma tongue was as common as PTLD.…”

Section: Discussionmentioning

confidence: 99%

Carcinoma of the tongue in renal transplant recipients: An unusual spectrum of de novo malignancy at a tertiary care center in India over a period of 26 years

Narayan

R²,

Srikant

et al. 2018

Indian J Nephrol

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Renal transplant recipients are at a higher risk of malignancy. We report our experience and the critical differences in the presentation of malignancy in kidney transplant patients performed at our tertiary care center and followed up over the period of 1990–2015. A total of 338 live donor transplants performed in 332 patients were analyzed. Induction immunosuppression was used in 22 cases with interleukin-2 (IL-2) receptor antibody. Overall 299 patients were continued on calcineurin inhibitor (CNI)-based triple drug immunosuppression, 33 were off CNI with 13 of them receiving sirolimus additionally. A total of 16 malignancies including post transplant lymphoproliferative disease (5), oral cancer (5), lung cancer (2), hepatobiliary cancer (2), colon cancer (1), and skin cancer (1) were diagnosed in 15 patients. Over the 26-year follow up, 138 patients died of whom 12 died due to cancer. Cancer occurred in 4.7% of patients but accounted for 9.4% of deaths. Oral cancer occurred after a significantly longer latency of over 10 years (212 vs. 94 months, P = 0.00652). Despite the longer latency, oral cancer patients were younger at diagnosis (44.0 vs. 52 years, P = 0.01016) and had better outcome (Fisher's exact test, P = 0.0275). This was despite a longer overall follow-up for the oral cancer patients, reflecting the better outcome for these patients (24 vs. 4 months, P = 0.0278). This might be the result of relatively early diagnosis of oral cancers.

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“…However, long-term exposure to immune suppressive drugs leads to chronic medical conditions such as posttransplant malignancies. [ 43 44 45 ] The most frequent malignancy after renal transplantation is NMSC. [ 46 ] Some factors are regarded to contribute to susceptibility for NMSC.…”

Section: Discussionmentioning

confidence: 99%

Incidence of nonmelanoma skin cancer in renal transplant recipients: A systematic review and meta-analysis

2018

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Background:Nonmelanoma skin cancer (NMSC) in renal transplant recipients is common and associated with significant morbidity and mortality. The aim of the present systematic review and meta-analysis was to estimate the incidence of NMSC among renal transplant recipients.Materials and Methods:We systematically searched PubMed, Medline, Scopus, and Web of Science databases for studies that assessed the incidence of NMSC in renal transplant recipients using a combination of relevant keywords. Two independent investigators included studies and extracted necessary information. Random effect meta-analysis was used to estimate pooled incidence of NMSC with 95% confidence intervals (CIs).Results:Twenty-nine studies comprising 36,021 patients meet the criteria for the systematic review. The pooled incidence of NMSC in renal transplant recipients was 12.6% (95% CI: 12%–14%) with a majority of squamous cell carcinoma (SCC) 55% (95% CI: 47%–63%). The pooled estimate of the incidence rates of SCC and basal cell carcinoma was 2.7% (95% CI: 2%–3.4%) and 2.2% (95% CI: 1.5%–2.8%), respectively. Subgroup analysis per geographic location showed that pooled incidence of NMSC was 39.1% (95% CI: 26.3%–51.8%), 12.4% (95% CI: 8.8%–16%), and 1.2% (95% CI: 0.4%–2%) in Australia and New Zealand, Europe, and Middle East, respectively.Conclusion:The results of the current meta-analysis demonstrated that the incidence of NMSC in renal transplant recipients varies widely. Regarding the high incidence of NMSC among renal transplant recipients, awareness of associated risk factors and early diagnosis of the malignancy in the population is a major clinical need.

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Posttransplant Malignancies in Renal Transplant Recipients: 22-years Experience from a Single Center in Pakistan

Cited by 7 publications

References 19 publications

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Carcinoma of the tongue in renal transplant recipients: An unusual spectrum of de novo malignancy at a tertiary care center in India over a period of 26 years

Incidence of nonmelanoma skin cancer in renal transplant recipients: A systematic review and meta-analysis

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