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  • We detail malignancies in organ transplant recipients as a whole.

  • Observations that apply exclusively to kidney recipients are specifically mentioned.


  • Increased incidence of cancers (two to four times) and cancer-related deaths among kidney transplant recipients when compared to the general population1,13

  • The risk is especially marked for malignancies associated with oncogenic viruses such as:

    • Epstein-Barr Virus (EBV, causing Post Transplant Lymphoproliferative Disease, PTLD)

    • Human Herpes Virus 8 (HHV-8, associated with Kaposi Sarcoma, KS)

    • Human Papilloma Virus (HPV, causing nonmelanoma skin cancers and anogenital cancers)13

  • Malignancies are a major cause of death with functioning grafts among kidney transplant recipients beyond 12 months after transplantation1

  • Cancers account for 8–10% of kidney transplant recipient deaths in the United States (2.6 deaths/1000 patients)1

  • Non-melanoma skin cancers (especially squamous cell carcinoma) are the most frequent malignancy in solid organ transplant recipients1,13

    • This incidence is as high as 30% in Australia (5/1000 patients)1

  • Genitourinary cancers are the second malignancy in terms of frequency after skin cancers among kidney transplant recipients1

  • Kidney transplant recipients show variation among types of cancers:1

    • Increased incidence:

      • Lung

      • Colon

      • Liver

      • Lymphoma

      • Melanoma

      • Nonmelanoma skin cancers

    • No reported increased incidence:

      • Prostate

      • Ovarian

      • Brain

      • Cervical cancers

    • Possible reduced incidence

      • Breast cancer

  • Increased risk among both dialysis patients and kidney transplant recipients:

    • Thyroid Cancer

    • Myeloma

    • Urinary tract cancers

  • Increased risk among transplant recipients than wait list candidates2

    • Nonmelanoma skin cancers

    • Melanoma

    • Kaposi sarcoma

    • Non-Hodgkin lymphoma

    • Mouth cancers

    • Skin cancers

  • Lower risk in transplant recipients than among wait list candidates:1,2

    • Ovarian cancer

    • Prostate cancer

  • Diagnosis of malignancy after transplantation:1

    • Age 40 (average)

    • Within 3–5 years after transplantation

      • Lymphomas and Kaposi sarcomas occur earlier

      • Epithelial cancers occur later

  • Renal cancers (85% papillary type, 15% clear cell) occur almost always in the native kidney/s (rather in the transplanted kidney)1,3:

    • Usually small

    • Can be managed with ablation therapy and no reduction in immunosuppression

  • The greater incidence of cardiovascular disease, chronic kidney disease, and infections among transplant recipients increases the risk of potential complications, morbidity, and mortality associated with medical and surgical oncologic interventions.4

  • Immunosuppressive agents may have a direct carcinogenic power that associates them with malignancies rather than an indirect effect via immunosuppression.4


  • Risk factors predisposing to malignancies:

    • Age

    • Donor type (from highest to lowest risk)

      • expanded criteria deceased > standard deceased > live donors

    • Immunosuppression

      • Also inclusive of use prior to transplantation for nontransplant indications

    • Length of pretransplant dialysis (increased risk with increased dialysis time)

    • Pretransplant cancers

      • 1.92 hazard ratio of developing de novo malignancies (for solid organ transplant recipients in general)1,5

    • Rejection

    • Sun exposure

      • Sun blockers and nicotinamide reduce risk of nonmelanoma skin cancers

    • Viral infections

      • Epstein-Barr virus (EBV; Hodgkin and non-Hodgkin lymphomas)

      • Human herpesvirus 8 (HHV-8; Kaposi sarcoma)

      • Human papillomavirus (HPV; cervix, vulva, vagina, anus, and some oropharynx cancers)

      • Merkel cell polyomavirus (Merkel ...

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