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Tumours after kidney transplantation

Lutz, Jens; Heemann, Uwe

Renal medicine and renal transplantation

Purpose of review: With the improved long-term outcome of renal allograft recipients, malignant tumours or cardiovascular disease become increasingly important. Malignant tumours develop in 15-20% of graft recipients after 10 years, and thus contribute substantially to the morbidity and mortality of these patients. In contrast to the general population, skin tumours and lymphoproliferative disorders are the most frequent malignancies in transplant recipients. Malignancies can develop in three ways: de-novo occurrence in the recipient; recurrent malignancy in the recipient; or transmission of malignancy from the donor.

Recent findings: The immunosuppressive strategies after renal transplantation differ with respect to the development of malignancies, with cell-depleting antibodies being the highest risk, whereas newer immunosuppressants such as rapamycin could possess anti-tumour potential. The relationship of chronic viral infections to skin tumours and lymphoproliferative diseases has become clearer during recent years. Concomitantly, experience in the management of such diseases has grown. Furthermore, as older donors are accepted, awareness of the possibility of transferring malignancies from the donor to the recipient must increase.

Summary: Malignancies are a major contributor to morbidity and mortality among kidney transplant recipients as such diseases gain importance with longer graft survival. Immunosuppression and chronic viral infections in combination with the transmission of malignant cells from the donor or recurrent malignancies contribute to the increased incidence of cancer. In kidney transplant recipients, screening before and after transplantation and an individualized choice of immunosuppression are thus mandatory.

Department of Nephrology, II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

Correspondence to Professor Dr. med. Uwe Heemann, Department of Nephrology, II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany Tel: +49 089 4140 2231; fax: +49 089 4140 4878; e-mail: uwe.heemann@lrz.tum.de

Abbreviations EBV: Epstein-Barr virus HHV-8: humanherpes virus type 8 HPV: human papilloma virus PTLD: posttransplant lymphoproliferative disease

© 2003 Lippincott Williams & Wilkins, Inc.