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  • Review Article
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Malignancy after renal transplantation: the role of immunosuppression

Nature Reviews Nephrology volume 6, pages 511–519 (2010)Cite this article

Subjects

Abstract

Outcomes of kidney transplantation, in terms of graft and patient survival, have improved over the past few decades, partly as a result of the introduction of new immunosuppressive drugs. Many immunosuppressive agents are associated with an increased risk of cardiovascular events and an increased risk of cancer, however, which can compromise patient survival. Cancer is more common among solid-organ transplant recipients than it is in the general population or in patients on dialysis. In fact, malignancy is the third most common cause of death in renal transplant recipients. Immunosuppressive treatments used in renal transplant recipients can cause malignancy by supporting oncogenesis caused by certain viruses or by impairing immune surveillance thereby enabling faster tumor growth. In this Review, we describe the epidemiological and clinical characteristics of common tumor types occurring after kidney transplantation, and the etiopathogenetic factors that lead to their appearance, with a particular focus on the relationship between immunosuppressive treatment and malignancy. Immunosuppressive drugs associated with an increased risk of malignancy after transplantation are also discussed, as are immunosuppressive drugs that seem to have antioncogenic properties.

Key Points

  • Malignancy is the third most common cause of death after renal transplantation

  • Common malignancies in renal transplant recipients include skin cancer, melanoma, Kaposi's sarcoma and post-transplantation lymphoproliferative disorders

  • Factors associated with the development of cancer in transplant recipients include carcinogenic factors, impaired immune surveillance owing to immunosuppression, a genetic predisposition to cancer and the presence of certain viral infections

  • Renal transplant recipients should be screened for cancer regularly after transplantation to enable early intervention when necessary

  • Immunosuppressive treatments in renal transplant recipients should be modulated to try and balance the risks of graft rejection and cancer development

  • Malignancies should be managed with specific therapies for the particular tumor type and with strategies such as immunosuppression reduction, immunosuppression withdrawal or conversion to alternative immunosuppressive regimens

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Figure 1: Factors associated with the development of cancer in renal transplant recipients.

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Acknowledgements

Laurie Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain

    Inés Rama & Josep M. Grinyó

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Rama, I., Grinyó, J. Malignancy after renal transplantation: the role of immunosuppression. Nat Rev Nephrol 6, 511–519 (2010). https://doi.org/10.1038/nrneph.2010.102

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