From the Guidelines
Kidney transplant recipients are at increased risk for colon cancer, as consistent evidence of increased incidence in SOTRs exists only for colorectal cancer. This increased risk stems from the immunosuppressive medications that transplant recipients must take to prevent organ rejection. These medications, including tacrolimus, cyclosporine, mycophenolate mofetil, and corticosteroids, while necessary for graft survival, impair the immune system's ability to identify and eliminate cancer cells. Additionally, they reduce immune surveillance against oncogenic viruses. The risk is particularly elevated for cancers with viral associations, such as human papillomavirus-related cancers.
- Key points to consider:
- The risk of colon cancer is increased in kidney transplant recipients, with a standardized incidence ratio (SIR) of 1.75, as reported in a study published in the Kidney International journal 1.
- The risk of other cancers, such as lung, breast, and uterine cancer, may also be increased in kidney transplant recipients, but the evidence is not as strong as it is for colon cancer.
- Transplant recipients should undergo more frequent cancer screenings than the general population, including regular colonoscopies, mammograms, Pap smears, and chest imaging as recommended by their transplant team.
- The risk increases with the duration of immunosuppression, with some studies suggesting a 2-4 fold higher overall cancer risk compared to age-matched controls, as noted in a study published in the American Journal of Transplantation journal 1.
- Patients should be vigilant about reporting any unusual symptoms and maintain regular follow-up appointments with their transplant physicians to ensure early detection of potential malignancies.
- A recent study published in the Kidney International journal found that the SIR for colon cancer in kidney transplant recipients was 2.36, which is significantly higher than the general population 1.
From the Research
Increased Risk of Cancer in Kidney Transplant Recipients
- Kidney transplant recipients have a higher risk of developing cancer compared to the general population, with an approximately two to three times greater risk 2.
- The most common type of cancer in kidney transplant recipients is nonmelanoma skin cancer, likely due to an interaction between ultraviolet radiation exposure and decreased immune surveillance 2.
- Viral-mediated cancers, such as post-transplant lymphoproliferative disorder, anogenital cancers, and Kaposi sarcoma, are also more common in kidney transplant recipients 2.
- The occurrence of solid organ cancers, such as breast, prostate, lung, and colorectal cancers, is not significantly increased in kidney transplant recipients, or is only mildly increased 2, 3.
Specific Cancers
- Lung cancer: there is no significant increase in the risk of lung cancer in kidney transplant recipients 2, 3.
- Colon cancer: there is no significant increase in the risk of colon cancer in kidney transplant recipients 2, 3.
- Breast cancer: there is no significant increase in the risk of breast cancer in kidney transplant recipients 2, 3.
- Uterine cancer: there is no specific information available on the risk of uterine cancer in kidney transplant recipients in the provided studies.
Management and Prevention
- Clinical care and future research should focus on prevention and improving outcomes for immunosuppression-related malignancies 2.
- Treatment options for cancers occurring in kidney transplant recipients may include conventional approaches, such as radiotherapy and chemotherapy, together with consideration of altering immunosuppression 4.
- Regular dermatological surveillance, sun protective behaviors, and other preventive measures can decrease the risk of skin cancer in kidney transplant recipients 5.