Renal cancer in kidney transplanted patients

Abstract

Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

Honokiol inhibits c-Met-HO-1 tumor-promoting pathway and its cross-talk with calcineurin inhibitor-mediated renal cancer growth

“…c-Met-mediated Ras activation plays a major role in the accelerated growth of renal cancer, which is also a critical problem in immuno-suppressed patients 4, 19, 21, 24 . Here, we report that HNK can effectively inhibit c-Met-mediated growth promoting pathways in RCC, involving the cytoprotective molecule HO-1.…”

“…Also, there is an unmet need to identify novel therapeutic drugs/approaches to effectively suppress CNI-induced tumor growth 19 . HNK is one such promising drug with both chemopreventive and anti-inflammatory properties 1 ; therefore, the use of HNK as a therapeutic for patients after organ transplantation can potentially have dual benefit, i.e.…”

“…Although aberrant c-Met and other RTK hyper-activation are the major drivers of renal cancer growth, recent reports clearly suggest an alarmingly high incidence of renal cancer in patients receiving calcineurin inhibitors (CNIs) as immunosuppressive therapy for the treatment of immune disorders or after having organ transplants 19–21 . The CNI Cyclosporine A (CsA) inhibits T cell activation, by down-regulating the phosphatase activity of calcineurin and preventing the nuclear translocation of NFAT, a crucial factor for T cell activation, and thereby suppresses immune system 22 .…”

Urologic malignancies in kidney transplantation

“…Goh et al recommended screening ultrasound every 2 years for patients with ACKD and every 5 years for recipients without ACKD . Frasca et al proposed annual screening ultrasound for patients with ADPKD or ACKD and every 2 years for patients older than 60 years who had been receiving dialysis longer than 5 years before transplantation …”

Kidney transplantation in patients with previous renal cancer: a critical appraisal of current evidence and guidelines

“…However, considering that transplanted patients inherently have an increased risk of cancer when compared with the general population, mainly due to prolonged immunosuppressive therapy [6], they should be evaluated carefully before listing, in order to avoid first of all the risk of worsening the patient prognosis instead of improving it, and secondly the use of a scarce resource, such as donated organs, for subjects with a limited life span.…”