Cancer after renal transplantation.

THE INCIDENCE of cancer after renal transplantation is remarkably higher than that in the general population, amounting to between 3% and 9%, with a 6% mean. Since 1968, when Dr Israel Penn founded the Cincinnati Transplant Tumor Registry (CTTR) now managed by Dr M. Roy First, the results of this registry have been collected and reported at regular 3 to 5 years intervals. From these results it can be deduced that the types of neoplasia frequently observed in the general population (lung, breast, prostate, colon, and uterine cervix) have not increased but rather they have decreased, in frequency. However, the incidence of other types of tumors uncommon in the general population is highly significant in transplanted patients: lymphoma 25% vs 5%; lip cancer 7% vs 0.3%; Kaposi’s sarcoma 6% vs a virtually negligible incidence; renal carcinoma 5% vs 2%; vulva and perineum carcinoma 4% vs 1.5%; hepatic and biliary tumors 2.6% vs 1.4% and sarcomas (including Kaposi) 1.7% vs 0.5%. The risk of occurrence of a tumor after renal transplantation depends on the tumor type and the time elapsed since transplantation. For Kaposi’s sarcoma it is about 22 months (1 to 225.5 months); 32 months for lymphomas (1 to 254 months); 69 months for epitheliomas (1 to 298.5 months); with vulva and perineal carcinoma having a much longer mean time of about 113 months (1 to 255 months). The probability of developing a malignant neoplasia in a renal transplant recipient monitored for 17 years is about 14% for noncutaneous cancers, 47% for skin carcinomas, and 55% for any other cancer type. The majority are diagnosed at 4 to 5 years after transplantation. We report the 32-year incidence and description of malignant tumors after renal transplantation. We examined 2121 transplants, 2006 corresponding to cadaveric donors and 115 to living donors, performed from 1970 to 2002 by the Asociacion Madrid Trasplante (Madrid transplantation association). (Hospital Puerta de Hierro, Fundacion Jimenez Diaz and Hospital Universitario Gregorio Maranon.)