39 De Novo Malignancies After Renal Transplantation – A Single Center Experience

Background  The occurrence of malignancies after organ transplantation is a well known and very serious complication. According to many authors, the overall prevalence of malignancies after renal transplantation is between 6 and 12%. Despite the fact that many factors could be involved, the etiopathogenesis is still unclear. The aim of the authors is to present their own clinical experience in early diagnosis and treatment of de novo malignancies after renal transplantation. Patients and Methods  Over a period of 12 years, 184 renal transplant (138 living related and 46 cadaveric) were performed and followed in our department on an outpatient basis. All patients were treated by sequential quadruple immunosuppressive protocol with mono (Il-2R antagonists) and polyclonal antibody (ATG) induction therapy and Cyclosporine A, Mycophenolate Mofetil or/and Azathioprine, and Prednisolone as maintenance therapy. The standard surgical and preservation procedure was performed in most of the patients. The mean cold ischemia time in living renal transplants was 3.6 h, while in cadaver was 25.6 h. About 20% of the patients developed acute rejection episodes, successfully treated by steroid pulse therapy. According to the protocol in the Department the patients were regularly examined once-monthly during the whole period of follow up. Results  Overall 18 malignancies (9.78%) in 14 patients (7.8%) were observed. All cases were clinically and histologically confirmed. Of 14 transplant patients with malignancies, 4 were female and 10 male. The mean age of patients with cancer was 45 years (range 21–53). Most of the malignancies were basal and/or squamous skin cancers (10 or 55%). Kaposi's sarcomas were found in 3 patients (16.6%, one visceral form). One breast cancer, one seminoma, one cancer of the colon, one urogenital cancer in female, one renal cell carcinoma and one plasmocytoma, were detected to. Surprisingly no cases of post-transplant lymphoproliferative disease (PTLD) were observed. All cancers were de novo malignancies presented in a mean time of 21 months (range 2–52 months) after surgery. The overall mortality rate was 42.6%, most among the patients with solid organ cancers. Three grafts were lost because of reduction and cessation of immunosuppression in patients with visceral form of Kaposi's sarcoma, multiple skin cancers and plasmocytoma. We did not observe any correlation between the clinical occurrence of post-transplant malignancies and different HLA type, number of rejection episodes as well as any specific bacterial, viral, or fungal infection. Conclusion  The prevalence of post-transplant malignancies in our group of patients is similar to other authors. The predominance of the skin cancers is understandable bearing in mind the sunny side of the country. Careful clinical examination and long-term screening protocols are needed for early detection and treatment of this mostly life threatening complication among the transplant population.