Objectives:
Kidney transplant recipients are at increased risk of malignancy compared to the general population. The prognosis of posttransplant malignancy is poor, and data on how to manage immunosuppression are scarce. This study aimed to evaluate posttransplant malignancy incidence and its effects on graft and patient survival in kidney transplant recipients.
Materials and Methods:
Six hundred and twenty-eight patients who underwent kidney transplantation between 2000 and 2019 were retrospectively examined. Demographic data, transplant and cancer characteristics, graft and patient survival of 33 patients (5.26%) diagnosed posttransplant malignancy were evaluated.
Results:
The average age at malignancy diagnosis was 48 years. Malignancy distribution was as follows: solid organ tumors (57.6%), non-melanoma skin cancers (24.2%) and posttransplant lymphoproliferative disease (18.2%). The time from transplantation to malignancy diagnosis was 66 months. Immunosuppression was reduced in 45.5% of the patients and 54.5% had switched to mammalian target of rapamycin inhibitors. In posttransplant lymphoproliferative disease, all patients received chemotherapy and immunosuppression was reduced in 83.3%. These rates were significantly lower in other malignancies (p=0.010 and p=0.032, respectively). Graft loss was observed in 4 patients (12.1%) and death was observed in 13 patients (39.4%). Immunosupression reduction was not associated with graft survival. Posttransplant lymphoproliferative disease had higher mortality (p=0.049) and shorter patient survival (p=0.006) compared with others.
Conclusion:
Cancer is an important cause of mortality in kidney transplant recipients. We showed that patient survival in posttransplant lymphoproliferative disease is lower than other malignancies. It is important for patients to undergo regular cancer screening appropriate to their age and other risk factors after transplantation. Randomized controlled studies are needed for the management of immunosuppressive treatments.
Keywords: Kidney transplantation, malignancy, survival
