Transplantation. 98(12):1286-1293, December 27, 2014.
Solid organ transplantation is associated with a risk of de novo and donor transmitted cancer – this is well recognised and potential recipients should be informed that this is a risk that can be reduced but not abolished. In this analysis of the Australian and New Zealand Dialysis and Transplant Registry, Ma and colleagues have assessed the risk of cancer (excluding donor transmitted cancer) in kidney recipients, comparing living, deceased standard and expanded criteria donors (ECD) and showed that the risks of cancer were greatest in recipients of ECD kidneys, especially for genitourinary and post-transplant lymphoproliferative disease. ECD was defined as donor aged 50 years or more with at least two of hypertension, cerebrovascular cause for brain death and renal impairment as shown by serum creatinine >133umol/L.
The authors hypothesise that this is related to a viral etiology although there is no clear evidence for this, or that it is related to increased immunosuppression or any other donor factors. Numbers are small (comparatively) so no impact on, for example, on Kaposi’s sarcoma could be identified and the inherent limitations of any analysis of registry data mean that a more detailed analysis could be undertaken to suggest which factors are relevant. The matching of donors and recipients, especially ECD donors, is not random so there may be associations that cannot be detected in the analysis. This study will also remind both clinicians and patients to be vigilant for development of certain cancers.