Cancer post kidney transplant: the question of risk
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EDITORIAL
Cancer post kidney transplant: the question of risk Georgina L. Irish1,2,3 · P. Toby Coates2,3 · Philip A. Clayton1,2,3
© Italian Society of Nephrology 2020
The risk of developing a cancer is one of the most feared and challenging complications after successful kidney transplantation. Sadly, cancer incidence is increased post kidney transplantation [1, 2] and remains a major cause of morbidity and mortality for kidney recipients. Post-transplant malignancies may be derived from the donor or the recipient, with each scenario involving different considerations. In this issue of the Journal of Nephrology, two studies report on each of these scenarios. The risk of donor transmitted cancers is fortunately low, and the risk of morbidity and mortality from such donor derived cancers varies based on malignancy type [3, 4]. A previous systematic review was undertaken in 2013, but there have been a number of studies published since this time [3]. A thorough understanding of the newer literature associated with donor cancer transmission is imperative to balance the risk of cancer transmission and mitigate against the risk of non-utilisation of life sustaining organs. In this issue of the Journal of Nephrology, Eccher et al. [4] analysed case reports and series of donor-transmitted cancer until August 2019. They reviewed 234 recipients from 128 papers. The rarity of these transmissions occurring, means that most of the literature in this area will be case series thus there will be a degree of reporting bias and clinical heterogeneity necessitating some caution in interpretation of these results. The most commonly transmitted cancers were lymphoma, renal cell cancer, melanoma and non-small cell lung cancer (NSCLC). Melanoma and NSCLC had the worst prognosis with renal cell cancer and lymphoma being more favourable. * P. Toby Coates [email protected] 1
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
2
School of Medicine, University of Adelaide, Adelaide, Australia
3
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
As expected, the most adverse prognostic factor was the presence of metastases. Interestingly, most diagnoses were made in the first 2 years post transplantation confirming the need for particular vigilance in recipient assessment over this time period. In regards to the different types of cancer, melanoma continues to be an insidious malignancy with diagnosis occurring late after transplantation with limited ability to predict the risk of recurrence. Renal cell carcinoma, conversely, had a more favourable prognosis and was mostly identified in the first year. It was treated predominantly with tumour or transplant nephrectomy, though some were merely observed. As the authors acknowledge in their discussion, distinguishing between donor derived lymphomas and post-transplant lymphoproliferative disease continues to pose
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