Cancer after kidney transplantation and immunosuppression

Between 1977-1998 we followed up 115 patients with renal allograft. Seventy patients had received a graft from a living donor, while 45 had received a graft from a cadaver donor. The immunosuppressive therapy included azathioprin (AZA), prednisolone (PRED) and cyclosporin A (CyA) in 90 patients and AZA and PRED in 25 patients. Nine patients showed skin malignancies (7.3%), three of these patients had Kaposi's sarcoma and the other six patients squamous or basal cell carcinoma. All cases were clinically and histologically confirmed. Squamous or basal cell carcinoma occurred mostly on the head and was radiosensitive, though recurrences might be observed. Kaposi's sarcoma was localized on either the lower extremities or the face. The condition of two patients treated by radiotherapy only partially improved. Due to chronic renal allograft rejection immunosuppressive therapy was withdrawn in two patients and dialysis was restarted without any other recurrence of the sarcoma. The rate of cancer occurrence in patients with renal allograft is consistent with the findings of other authors. Reduction or withdrawal of immunosuppressive therapy may have a beneficial effect on malignancy, but incurs the risk of losing the allograft.