Malignancy after kidney transplantation: results of 400 patients from a single center

: Background:  Post‐transplant malignancies (PTM) occur in a percentage as high as 50% in patients followed 20 yr and have become a main cause of mortality and are expected to be the first cause of death within the next 20 yr in kidney transplant recipients. Patients and methods:  We analyzed the PT...

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Bibliographic Details
Published in:Clinical transplantation 2008-07, Vol.22 (4), p.424-427
Main Authors: Stratta, Piero, Morellini, Veronica, Musetti, Claudio, Turello, Ernesto, Palmieri, Daniela, Lazzarich, Elisa, Cena, Tiziana, Magnani, Corrado
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
cancer-free survival
Female
Follow-Up Studies
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Rejection
Graft Survival - physiology
Humans
Incidence
Kidney Transplantation
Male
malignancy
Medical sciences
Middle Aged
Neoplasms - epidemiology
Neoplasms - etiology
Postoperative Complications
prognostic factors
Retrospective Studies
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival Rate
Tissue, organ and graft immunology
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Summary:: Background:  Post‐transplant malignancies (PTM) occur in a percentage as high as 50% in patients followed 20 yr and have become a main cause of mortality and are expected to be the first cause of death within the next 20 yr in kidney transplant recipients. Patients and methods:  We analyzed the PTM incidence in our kidney transplant recipients, and its main risk factors. The records of 400 patients (min follow up = one yr) have been retrospectively reviewed and categorized into three groups: patients without any tumor, with a non‐melanoma skin cancer and with a solid or hematologic cancer. A cancer‐free multivariate survival study was performed stratified by age, sex, immunosuppressive therapy, time on dialysis, body mass index (BMI), smoke, diabetes and nephropathy. Results:  Thirty patients developed PTM: 12 non‐melanoma skin cancer, three lymphomas and 15 solid malignancies (seven genitourinary, three lung, two breast, two gastrointestinal and one sarcoma). The mean age at diagnosis was 55 yr, with a mean time from transplant of 27 months. We observed six deaths and two graft losses. Non‐melanoma skin cancer‐free survival and the solid/hematologic cancer‐free survival was 99.5% and 98.5% at one yr, and 95.2% and 94.6% at five yr, respectively. At univariate analysis, age and induction therapy were significant risk factors for both types of PTM, while only recipient age significantly increased the risk of all PTM, and anti CD25 significantly reduced the risk of non‐melanoma skin cancer at the multivariate study. Conclusions:  These data confirm the role of age and induction strategies in modulating the risk of neoplasia. To look for which strategies might reduce the PTM risk, including a personalized therapy to minimize the effects of chronic immunosuppressant, will be a crucial goal.
ISSN:0902-0063
1399-0012
DOI:10.1111/j.1399-0012.2008.00802.x