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04-07-2018 | Renal cell carcinoma | Article

Cancer in kidney transplant recipients

Journal: Nature Reviews Nephrology

Authors: Eric Au, Germaine Wong, Jeremy R. Chapman

Publisher: Nature Publishing Group UK

Abstract

Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients after cardiovascular disease. Kidney transplant recipients have at least a twofold higher risk of developing or dying from cancer than the general population. The increased risk of de novo and recurrent cancer in transplant recipients is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. Transplant candidates and potential donors should be screened for cancer as part of the assessment process. For potential recipients with a prior history of cancer, waiting periods of 2–5 years after remission — largely depending on the cancer type and stage of initial cancer diagnosis — are recommended. Post-transplantation cancer screening needs to be tailored to the individual patient, considering the cancer risk of the individual, comorbidities, overall prognosis and the screening preferences of the patient. In kidney transplant recipients diagnosed with cancer, treatment includes conventional approaches, such as radiotherapy and chemotherapy, together with consideration of altering immunosuppression. As the benefits of transplantation compared with dialysis in potential transplant candidates with a history of cancer have not been assessed, current clinical practice relies on evidence from observational studies and registry analyses.

Solid organ cancers

All cancers except soft tissue cancers and skin cancers such as non-melanoma skin cancer and melanoma.

Post-transplant lymphoproliferative disorder

(PTLD). Cancers due to abnormal cell proliferation in lymphoid tissue, which can occur after transplantation.

Standardized mortality ratio

(SMR). A ratio of the mortality of a population of interest, such as kidney transplant recipients, to the mortality of the general population, matched (standardized) by age and gender. This methodology allows for the comparison of the mortality of groups with different age and gender distributions with that of the general population.

Aristolochic acid

A group of compounds found in plants and traditional herbal medicines that are associated with the development of kidney failure as well as cancers of the bladder and urinary tract.

Cyclophosphamide

A chemotherapy agent that is used for the treatment of certain diseases, including some types of glomerulonephritis and cancer. The compound has been associated with the development of urothelial carcinoma.

Induction therapy

A short course of intense immunosuppressive therapy given at the start of transplantation to prevent acute rejection.

Panel reactive antibody

(PRA). An immunological test performed in potential transplant recipients to determine the presence of antibodies against a panel of possible donors. Results are presented on a scale of 0–99%, with a higher number indicating antibodies that react to a greater percentage of donors in the panel.

HLA-DR mismatches

Human leukocyte antigens, such as HLA-DR, are specific proteins on the surface of cells. A difference or mismatch of these antigens (HLA mismatch) between potential transplant donors and recipients can increase the risk of rejection.

Expanded criteria donor

A deceased donor who was aged ≥60 years or who was aged 50–59 with two of three factors: history of hypertension, elevated creatinine at time of death (>1.5 mg/dl) or suffered a cerebrovascular accident causing death.

Immunosenescent T cells

T cells that are functionally exhausted with impaired ability to proliferate and produce cytokines. This phenotype can occur through DNA damage (cellular senescence) or through repeated antigen stimulation and T cell replication (replicative senescence).

Backtable resection

Resection (of tumour or other part of the transplant organ) that occurs in the operating theatre but away from the recipient and before transplantation of the organ into the recipient.

Benign breast disease

A term for non-malignant diseases of the breast that can be detected on mammography, such as fibroadenoma and fibrocystic disease.

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Medicine Matters Oncology

Abstract