Low incidence of malignancies following renal transplantation in India

Summary: Renal transplant recipients have an increased incidence of certain malignancies. the nature of these malignancies varies with the geographic location and the nature of immunosuppressive therapy. There are no reports on the incidence and spectrum of cancers in renal transplant recipients from India. In a retrospective analysis of 294 patients followed up for more than 6 months after transplantation at our centre, we noted six malignancies in four patients, giving an incidence of 2%. Among 157 of those who were followed up for more than 2 years, the incidence was 3.8%. the mean duration of follow up was 5.8 years (range 6 months to 18.5 years). Cyclosporine was given for the first year after transplantation in 168 patients and 126 patients received only azathioprine and steroids. the interval between transplantation and development of malignancies varied from 24 to 169 months. the tumours included extranodal non-Hodgkin's lymphoma (NHL) involving the central nervous system and small bowel and carcinoma of the tongue in one case each. the fourth patient, who survived for 14 years after transplantation, developed three squamous cell malignancies during this period: carcinoma of the cervix, perianal region and nasopharynx. Both patients with NHL died despite surgical excision of the tumour. None of the patients developed a cutaneous malignancy. In conclusion, renal transplant recipients living in a tropical environment have alow incidence of malignancies compared to those in temperate zones. This discrepancy can be explained by an absence of malignant tumours of the exposed skin in our patients. the absence of any tumours within the first 2 years is also unusual.     

Radiation-Induced Brain Tumours: Potential Late Complications of Radiation Therapy for Brain Tumours

Summary  The development of neoplasms subsequent to therapeutic cranial irradiation is a rare but serious and potentially fatal complication. In this study, we retrospectively reviewed the clinical and pathological aspects of 11 patients who underwent cranial irradiation (range, 24–110 cGy) to treat their primary disease and thereafter developed secondary tumours within a span of 13 years. All tumours arose within the previous radiation fields, and satisfied the widely used criteria for the definition of radiation-induced neoplasms. There was no sex predominance (M: 5, F: 6) and the patients tended to be young at irradiation (1.3–42 years; median age: 22 years). The median latency period before the detection of the secondary tumour was 14.5 years (range: 6.5–24 years). Meningiomas developed in 5 patients, sarcomas in 4, and malignant gliomas in 2. A pre-operative diagnosis of a secondary tumour was correctly obtained in 10 patients based on the neuro-imaging as well as nuclear medicine findings. All patients underwent a surgical removal of the secondary tumour, 3 underwent additional chemotherapy, and one received stereotactic secondary irradiation therapy. During a median of 2 years of follow-up review after the diagnosis of a secondary tumour, 3 patients died related to the secondary tumours (2 sarcomas, 1 glioblastoma), one died of a recurrent primary glioma, while the remaining 7 have been alive for from 10 months to 12 years after being treated for the secondary tumours (median: 3 years). Based on these data, the clinicopathological characteristics and possible role of treatment for secondary tumours are briefly discussed.     

The Role of Microscopic Hematuria in the Evaluation of Urologic Malignancy in Renal Transplant Recipients

Urologic malignancy is a relatively uncommon but serious complication following kidney transplantation. The reported prevalence of renal cell carcinoma (RCC) of the native kidneys is 4.4% and of bladder malignancy is 2.6%. However, presently there are no universal guidelines for prospective screening of urologic malignancies after kidney transplantation. We routinely monitored all renal transplant recipients for microscopic hematuria and persistent hematuria (>3 separate occasions) results in imaging studies (ultrasound or computed tomography scan) of both native kidneys and the allograft. Cystoscopy is performed if imaging studies are negative. This retrospective study identified a total of 18 urologic malignancies among the study cohort, which consisted of 539 patients with an incidence of 3.3% (12 cases of RCC of native kidneys [10/12 had hematuria], and six cases of bladder and ureteral malignancies [6/6 had hematuria]). There were no significant differences between cyclosporine- and tacrolimus-based immunosuppression (IS). Among RCC recipients, two lost the allograft from chronic allograft nephropathy and one patient died unrelated to malignancy. Among patients with bladder and ureteral malignancies, two lost the graft possibly from IS reduction and one had BK virus nephropathy prior to diagnosis of bladder carcinoma. In conclusion, screening transplant recipients routinely for persistent microscopic hematuria may identify urologic malignancies in renal transplant recipients.     

Malignancies after pediatric kidney transplantation: more than PTLD?

Post-transplant lymphoproliferative disease (PTLD) is the most frequent malignant complication of transplantation in childhood. Even with modern post-transplant immunosuppressive strategies, 1–2 % of all kidney transplant recipients will develop PTLD within the first 5 years after transplantation, and the risk remains high even thereafter as long as immunosuppression is required. In addition to PTLD, adult kidney transplant recipients have an increased incidence of other immunosuppression-related malignancies, such as non-melanoma skin cancer or Kaposi’s sarcoma. It is foreseeable that pediatric transplant recipients will face similar complications during their adult life. Not only immunosuppression but also other risk factors have been identified for some of these malignancies. Strategies addressing these risk factors during childhood may contribute to life-long cancer prevention. Furthermore, early recognition and regular screening may facilitate early diagnosis and treatment, thereby reducing transplant-related morbidity. In this review we focus on malignant complications after renal transplantation and discuss known risk factors. We also review current screening strategies for malignancies during post-transplant follow-up.     

Malignancy in renal recipients

BACKGROUND: Immunosuppressed organ transplant recipients are more susceptible to cancer than are persons in the general population. If malignancies of the skin are excluded for geographic variation, a cancer incidence of 4% to 7% in transplant recipients is usual. OBJECTIVES: We aimed to find the incidence, histopathological types, and outcome of malignancy in kidney transplant recipients in Kuwait. PATIENTS AND METHODS: Between 1972 and October 2004, more than 1500 kidney recipients were followed. After excluding recipients who left the country soon after transplantation, we reviewed the medical records of the remaining 1171 kidney recipients (724 male and 447 female patients of ages 3 to 76 years) at the time of transplantation. Kidney grafts were obtained from 968 living and 203 deceased donors. Records were retrospectively reviewed for the incidence, clinical presentation, histopathological patterns, and outcome of cancer. RESULTS: Fifty-six malignant lesions (4.8%) were diagnosed in 51 recipients (28 men and 23 women, aged 15 to 66 years), who had received grafts from 44 living and seven cadaveric donors. Malignancy was diagnosed 4 to 288 months after transplantation. The most commonest types were posttransplantation lymphoma and Kaposi's sarcoma. Posttransplantation cancer presented earlier in female and in adult recipients and following decreased donor transplantation. Kaposi's sarcoma appeared earlier than posttransplantation lymphoma or squamous cell carcinoma. Less than 40% of recipients with malignancy are alive.     

Early de novo malignancies after kidney transplantation

INTRODUCTION: Immunosuppressed renal transplant patients display a higher incidence of carcinoma than the general population. The chronic use of immunosuppressive therapy to prevent acute rejection increases the long-term risk of cancer. We reviewed our experience to identify factors affecting the development of de novo neoplasms. PATIENTS AND METHODS: Between January 2000 and May 2003, 135 renal and three combined kidney-pancreas transplantations were performed. RESULTS: Sixteen (11.6%) cancers were diagnosed in nine renal transplant recipients (6.5%). Tumors presented at a mean time of 14 months. Three patients displayed in malignancies; three, Kaposi's sarcoma; one, papillary microcarcinoma of the thyroid; one, bladder carcinoma; and one, breast carcinoma. CONCLUSION: Although de novo malignancies occur more frequently many years after kidney transplantation, our experience demonstrates that they can occur early during the posttransplant follow-up. Skin malignancies showed the best prognosis, probably because of early detection and treatment. Patients with Kaposi's sarcoma benefit from reduction or cessation of immunosuppression, but this entails a higher risk of graft loss. Solid organ de novo malignancies are often more aggressive than those in normal population; the life expectancy of these recipients is low.     

Malignant neoplasms in cardiac transplant recipients

Purpose: Heart transplant recipients have an increased risk of posttransplantation lymphoproliferative disorders (PTLD) associated with monoclonal antilymphocyte (OKT₃) immunosuppression and Epstein-Barr viral (EBV) infections. These studies were undertaken to determine whether polyclonal antilymphocyte therapy can reduce the incidence of malignant neoplasia.Methods: We reviewed our experience with polyclonal induction therapy to assess the risk of malignant neoplasms in 223 transplant recipients between April 1985 and September 1998. Posttransplant immunosuppression therapy employed either polyclonal antilymphocyte or antithymocyte globulin given as 10mg/kg/day in divided doses for 3 days followed by cyclosporine, azothioprine, and steroids. OKT₃ was used in only 2 patients for persistent rejection.Results: Twenty-nine patients developed invasive malignant neoplasms (a mean of 57.9 months posttransplant; range 7 to 125). Invasive malignancies included carcinoma of the lung (7 patients), colon (3), kidney (3), bladder (2), prostate (1), squamous cell carcinoma of the tongue (1), malignant melanoma (2), Kaposi’s sarcoma (1), and squamous cell carcinoma of the anus (1). Five patients developed lymphoma: 3 patients had PTLD, 2 patients had Hodgkin’s and non-Hodgkin’s lymphoma. Positive EBV IgG titers (>4:1) were found in 3 patients, but only 1 of these developed PTLD and none of these patients received OKT₃. Of the 29 patients with invasive malignancy, 13 (45%) died secondary to their malignancy; 5 died of unrelated causes (sepsis, myocardial infarction, and organ failure); and 11 are alive after surgical excision and/or chemotherapy. The age-adjusted incidence of invasive neoplasm was 7.33 (95% 5.95 confidence interval 8.09) times as great as rates for the general population in the State of Michigan between 1988 and 1995.Conclusion: While induction polyclonal antilymphocyte therapy may reduce the risk of PTLD, the incidence of posttransplant malignancy remains high. A vigilant cancer surveillance protocol is mandatory in these high-risk patients.     

De novo renal cell carcinoma of native and graft kidneys in renal transplant recipients

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Immmunosuppression is an etablished risk factor for development of different maligancies. Nevertheless, little is known about the behaviour of renal cell cancer of native and graft kidneys in renal transplanted patients. The study results show an increased incidence of renal cell carcinoma in renal transplant recipients with high prevalence of papillary subtype, significantly younger patient age at the immunosuppression onset, aggressive behaviour with an increased tendency to systemic advance despite a high rate of low‐stage and low‐grade carcinomas at diagnosis. Furthermore, graft tumours had a more favourable prognosis than those of native kidney.

OBJECTIVE

• ? To access the epidemiological, clinical and survival features of renal transplant patients with de novo renal cell carcinoma of native and graft kidneys.

PATIENTS AND METHODS

• ? We performed a retrospective examination of the data of 2001 consecutive renal transplant recipients at our centre between November 1979 and January 2010.

RESULTS

• ? In the patient cohort examined, 30 renal cell carcinomas were observed in 26 individuals (incidence 1.5%) with 25 tumours in the native and five in allograft kidneys. Mean tumour size in surgical specimens was 44 ± 36 mm. The rate of papillary cancer was 37.5%.
• ? After a mean follow‐up of 58.6 ± 62.3 months, 15.4% of the patients died from cancer and 57.7% were in complete remission.
• ? Overall and tumour‐specific survival rates at 1, 5 and 10 years were 86.1%, 75.1% and 43.8%, and 90.4%, 83.5% and 66.8%, respectively.

CONCLUSIONS

• ? Due to increasingly improved survival after renal transplantation, de novo malignancies might soon become the main cause of intermediate‐ or long‐term mortality.
• ? Current data support an increased risk of renal cell carcinoma in renal transplant recipients in a particularly aggressive way, but low tendency for metachronous contralateral evolution.
• ? With continuous radiological follow‐ups, acceptable oncological outcome can be achieved. Graft tumours may have a favourable prognosis.

     

Malignant Neoplasm in Kidney Transplantation

Background: The kidney recipient is at a higher risk for cancer than is the general population, although the incidence of neoplasms in general is considered lower in Japan than in Western countries. The cause of this increased risk associated with either transplantation or geography has not yet been established.
Method: The incidences and sites of malignant neoplasms were analyzed in 285 kidney recipients, who had been followed up for 3007 patient-years. The relationship between immunosuppressive states, the numbers of CD4-positive T lymphocytes, and the presence of malignant neoplasms was studied retrospectively.
Results: Eighteen malignant neoplasms were found in 1 7 of the 285 patients (6%). The malignancies developed in these patients an average of 1 26.5 months aftertransplantation. The incidencewasonly3.9% at 1 0 years, increasing to1 3.9% at 20 years. No difference in the time-course incidence was found between azathioprine-based and cyclosporin-based immunosuppressive regimens. The malignancies developed in the digestive organs in more than half of the patients, and were mainly in the liver, colon and rectum, and stomach, with a relatively low incidence of skin cancer and lymphoma. There was only one case of Epstein-Barr virus genome found in 5 specimens that were tested. Concerning the immunosuppressive state, CD4-positive T lymphocyte counts were not related directly with malignancies in our series.
Conclusion: The cumulative incidence of malignancy increased markedly in the second posttransplant decade. The site of cancers in kidney recipients mirrors that of general Japanese malignancies. Our results revealed neither the cause nor predictor for malignancies in kidney transplant patients.     

The Incidence of Tumours in Renal Transplant Recipients with Long-Term Immunosuppressive Therapy

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.     

Neoplastic disease after heart transplantation: single center experience.

OBJECTIVES: Mandatory use of prolonged immunosuppression in organ transplantation is complicated by an increased incidence of cancer. The current study represents a retrospective analysis of the incidence of neoplasms in our heart transplantation program. METHODS: Four-hundred and seventy-four patients (403 male and 71 female; mean age, 48.6+/-12.1 years), with at least 30 days of follow-up, were enrolled in this study. Patients received triple immunosuppression with cyclosporin A, azathioprine and steroids. Moreover, as a prophylactic anti-lymphocyte therapy, 388 patients (82%) were administered RATG, 67 patients (14%) received ALG and 19 patients (4%) OKT3. The mean follow-up time was 71.1+/-43.0 months. RESULTS: Fifty-five patients (11.6%) developed malignant neoplasms. The cancer frequencies were: solid tumors, 55%; non-Hodgkin lymphomas (NHL), 20%; Kaposi's sarcomas, 11%; skin cancers, 9%; undifferentiated sarcomas and myelomas, 5%. Solid tumors mainly affected the lung (39%), bowel (16%), stomach (6.5%), liver (6.5%), pancreas (6.5%) and oral cavity (6.5%). The times to the onset of cancer from transplantation were: Kaposi's sarcoma, 12.7+/-16.8 months; skin cancers, 34.5+/-23.8 months; solid tumors, 54.3+/-38.7 months; NHL, 60.1+/-36.4 months; undifferentiated sarcomas and myelomas, 90.0+/-15.6 months. As determined by univariate and multivariate analyses, sex, number of treated rejections, previous history of tumor, average dose of cyclosporine and prednisone and cyclosporine blood levels did not increase the incidence of malignancies. Univariate analysis suggests a significant correlation between the type of prophylactic immunoglobulins and the average dose of azathioprine with the incidence of neoplasms. Both univariate and multivariate analyses demonstrated a significant correlation between patient's age at the time of transplantation and risk of cancer occurrence (risk increased by 1.074/year; P=0.0056 with multivariate Cox regression). CONCLUSIONS: Cancer is a strong limitation for long-term survival after heart transplantation. The only risk factor recognized is the patient's age at the time of transplant. Furthermore, the type of prophylactic globulins used for induction therapy and some specific immunosuppressant agent (azathioprine) may play a significant role in the development of malignancies after transplantation.     

Renal cell carcinoma of native kidney in renal transplant recipients

OBJECTIVE: To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients. PATIENTS AND METHODS: We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis. RESULTS: Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics. CONCLUSIONS: There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.     

Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation

OBJECTIVE

To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant.

PATIENTS AND METHODS

Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities.

RESULTS

Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow‐up of 25 and 32 months. The follow‐up, which included 3‐monthly renal ultrasonography and chest X‐rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months.

CONCLUSIONS

From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression.     

Prevalence of cancers in Korean recipients of renal transplants

SUMMARY: Cancer is a complication in immunosuppressed transplant recipients, and is widely recognized. of the 10 029 Korean recipients of renal transplants in 1975–1999, cancer developed in 193 (1.9%). the total number of cancers was 197, with four patients developing two cancers. Only the patients with cancers were reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, and the method of treatment and survival. In 108 males and 85 females (mean age 40.7 years), cancer developed approximately 64.9 months after renal transplantation. Eighteen patients received conventional immunosuppression-azathioprine with prednisone, and another 175 patients received cyclosporin-containing immunosuppression therapy. Twenty-two patients had skin cancers, 21 patients had Kaposi's sarcoma, 17 patients had post-transplantation lymphoproliferative disorder, two patients had myelodysplastic syndrome, and 132 patients had solid cancers, respectively. One hundred and nine patients underwent surgical treatment; 88 patients with advanced disease received radiotherapy, chemotherapy or symptomatic therapy. One hundred and twenty-one (62.7%) patients are alive, with no evidence of disease 42.2 months (on average) following the diagnosis of cancer. Another 11 patients were lost to follow up. Forty-nine patients died of progressive malignant disease, and 12 died of other causes. the average survival of dead patients with cancers was approximately 9 months (the mean survival period of dead patients caused by progressive malignant disease was 7.7 months). the time of diagnosis of cancers ranged from 2 to 240 months after kidney transplantation. We conclude that in immunosuppressed renal transplant recipients, the possibility of the development of cancer always should be considered. and we recommend follow up of appropriate intervals for signs of cancer over a long period.     

De novo malignancies after kidney and liver transplantations: experience on 582 consecutive cases

De novo malignancies after transplantation are a growing problem of solid organ transplant recipients, due to longer survival follow-up under chronic immunosuppression. The aim of this study was to analyze a population of 582 consecutive kidney (n = 382) and liver (n = 202) transplant recipients, who survived at least 12 months after transplantation, at a single transplant center for the development of de novo cancers. The incidence of de novo malignancies was 7% after both renal and liver transplantation. The median elapsed time from transplant to the diagnosis of de novo malignancy was 45 months (range 3 to 220) months for kidney and 37 months (range 12 to 101 months) for liver transplants. Skin cancers were the most common within renal recipients, while gastroenteric cancers were more frequently encountered in liver transplants. Oropharyngeal and upper digestive tract tumors were always associated with a history of chronic alcohol consumption in liver recipients. Liver transplant recipients treated for acute rejection had a worse cancer prognosis than patients without rejection 1- and 2-year survivals 83% and 63% versus 36% and 17% (P = .026). The estimated 1- and 2-year survival rates for all types of de novo malignancies were 79% and 66%, including 64% and 51% for solid organ tumors versus 89% and 89% for skin cancers and posttransplant lymphoproliferative disorder (PTLD) (P = .17) in renal transplants and 70% and 42%, including 57% and 28% for solid organ tumors versus 85% and 64% for skin cancers and PTLD (P = .43) in liver transplants respectively.     

Incidence and prognosis of cancer following heart transplantation using RATG induction therapy

Cancer limits survival following heart transplantation. The study's objectives were to evaluate the incidence and risk factors for cancers after heart transplantation and to assess the association between i.v. thymoglobuline induction therapy [rabbit antithymocyte immunoglobulin, (RATG)] and neoplasia. From 1982 to 2002, prospective data were gathered for 207 heart transplant recipients. Except from 1982 to 1987, all patients received a 3-day course of i.v. RATG following transplantation. Forty-three malignant neoplasms (21%) were diagnosed. The most common were: skin (42%), lung (12%), prostate (9%), genitourinary (9%) and lymphoma (5%). Mean length of follow-up after transplantation was 99 +/- 57 months. Mean survival after diagnosis was 52 +/- 44 months. Multivariate analysis showed no significant increase in the incidence of cancer with recipient age, sex, number of rejection episodes, the type of immunosuppression or the use of RATG. Patients receiving RATG developed their malignancies significantly earlier after transplantation (P =0.007) and succumbed faster after the diagnosis (P = 0.06). Cancer is a limiting event for long-term survival after heart transplantation. No individual risk factors allow predicting its development. In the present cohort, RATG does not have carcinogenic effects following transplantation, but is associated with a more precocious development of malignancies.     

肾移植受者发生的恶性肿瘤

目的 提高对肾移植后发生恶性肿瘤的诊治水平。方法 总结18例肾移植受者术后发生恶性肿瘤的临床资料，并进行随访。结果 18例患者在发现肿瘤时，13例移植肾功能良好，5例血肌酐升高；有9例患者为晚期肿瘤，已发生肿瘤浸润或远处转移，其中8例在3个月内死亡；9例患者接受手术、化疗或放疗，除1例非何杰金氏淋巴肉瘤和1例基底细胞癌分别于治疗后7个月、13个月死于肿瘤转移外，其余7例至今仍带肾存活。结论 （1）肾移植受者免疫功能低下，易发生恶性肿瘤；（2）早诊断、早治疗是有效的治疗方法，预后良好；（5）肾移植术后肿瘤患者应减少免疫抑制剂用量，实体瘤应尽早手术。     

Skin cancer in liver transplant recipients

Skin cancer is the most common malignancy arising inthe posttransplantation setting. Multiple factors contribute to the high risk for cutaneous carcinoma in immunosuppressed organ-transplant recipients. We review the phenomenon of skin cancer in solid-organ transplant recipients and further delineate the problem in the context of liver transplantation. Skin cancer is a significant medical and surgical problem for organ-transplant recipients. With prolonged allograft function and patient survival, the majority of solid-organ transplant recipients will eventually develop skin cancer. Although squamous cell carcinoma is the most common cutaneous malignancy in this population, basal cell carcinoma, melanoma, and Kaposi's sarcoma, as well as uncommon skin malignancies, may occur. Highly susceptible patients may develop hundreds of squamous cell carcinomas, which may be life threatening. Management strategies focus on regular full-skin and nodal examination, aggressive treatment of established malignancies, and prophylactic measures to reduce the risk for additional photodamage and malignant transformation. Skin cancer is a substantial cause of morbidity and even mortality among solid-organ transplant recipients. As a byproduct of immunosuppression, liver transplant recipients experience a high incidence of skin cancer and should be educated and managed accordingly.     

The janus face of immunosuppression - de novo malignancy after renal transplantation: the experience of the Transplantation Center Munich

After decades of successful organ transplantation clinicians continue to be troubled by the increasing incidence of cancers under maintenance immunosuppression. In this study, we examined rates of malignancies in 2419 renal transplant recipients transplanted in our institution between 1978 and 2005. In renal transplant recipients the cumulative incidence of cancer after 25 years was 49.3% for all tumors and 39.7% excluding non-melanoma skin cancers, compared with 21% for a normal sex- and age-matched population. The most frequent tumors observed were non-melanoma skin cancers (20.5%), kidney cancers (12.0%), and cancers of the pharynx, larynx, or oral cavity (8.2%). The general increase of cancer risk was 4.3-fold. Independent risk factors for the development of a tumor were male gender, older recipient age, the presence of preformed antibodies before transplantation, and the time on immunosuppression. Interestingly, the use of IL-2-receptor antagonists significantly reduced the tumor risk of transplant recipients. The tumor risk between immunosuppressive drugs typically used for maintenance immunosuppression was not significantly different. However, mammalian target of rapamycin (mTOR) inhibitor-based immunosuppressive protocols showed a clear tendency for lower malignancy rates. De novo malignancies following renal transplantation represent a serious problem endangering the prognosis of otherwise successfully transplanted patients. Future studies will have to address whether optimized immunosuppressive regimens including mTOR-inhibitors are capable of reducing the incidence or preventing the development of posttransplant malignancies.     

Urologic malignancies in kidney transplantation

With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long‐term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7‐fold risk of renal cell carcinoma (RCC) and 3‐fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.