De novo Cancer in Renal Transplant Recipients

Abstract

The increased risk and different behavior of de novo cancer in immunosuppressed transplant recipients is widely is widely accepted. Also, a different pattern of cancer incidence is observed based on the type of immunosuppressive agents. But the incidence and the predominant type of cancer in Asian countries is different from that of Western countries. Herein, we report on the incidence and pattern of de novo cancer in renal transplant recipients at Yonsei University Hospital. We reviewed 1,313 patients who underwent kidney transplantation at our hospital from April, 1979 through July. 1995. One hundred and sixteen patients received azathioprine(AZA) based immunosuppression and 1197 patients received cyclosporin(CyA) based immunosuppression. All cancers were confirmed by pathological study. The results were as follows; 1) The overall cancer incidence was 1.52%(20 of 1313 patients) but the cancer incidence increased as follow up time increased. Cancer incidence in recipients whose follow up duration was less than 3 years it was 0.27%, between 3 and 6 years was 1.44% and for more than 6 years was 2.95%(p=0.015). 2) There was no difference in cancer incidence according to the type of immunosuppressive agent. There was no relationship between the episode of early rejection(onset within 1 month) and cancer incidence(1.68% vs. 1.37%, p=0.2468). 3) The mean interval between renal transplantation and cancer diagnosis was 45.6 months. The mean age of cancer diagnosis was 44.8% years. 4) The sites of cancer were cervix(n=6, 30%), GI(n=4, 20%), lung(n=3, 15%), thyroid(n=3, 15%), skin(n=1, 5%), Kaposi's sarcoma(n=1, 5%), lymphoma(n=1, 5%) and plasmocytoma of gingiva(n=1, 5%). The incidence of skin cancer and lymphoma was lower than that in Western countries. 5) De novo cancer such as early stage stomach cancer, cervical cancer, thyroid cancer and skin cancer were treated with only surgical excision without any modulation of immunosuppressive agents with the exception of Kaposi's sarcoma and lymphoma. 6) Cancer related mortality was 20%(4 of 20 patients) and all of these patients had advanced-stage cancer at the time of diagnosis. Therefore, early detection of de novo cancer during the follow up period is recommended to decrease the cancer induced mortality in transplant recipients.