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Malignancy after renal transplantation: the role of immunosuppression
1Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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.
Insights
Kidney transplant recipients face higher cancer risks due to immunosuppressive drugs, which impair immune surveillance. This review details common cancers, their causes, and the impact of immunosuppression on malignancy after transplantation.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Kidney transplantation outcomes have improved with new immunosuppressive drugs.
- However, these drugs increase risks of cardiovascular events and cancer, compromising survival.
- Malignancy is the third leading cause of death in renal transplant recipients.
Purpose of the Study:
- To review epidemiological and clinical characteristics of post-transplant cancers.
- To explore etiopathogenetic factors, focusing on immunosuppressive treatment's role.
- To discuss immunosuppressive drugs' association with malignancy risk and potential antioncogenic properties.
Main Methods:
- Literature review of studies on kidney transplantation and malignancy.
- Analysis of epidemiological data on cancer incidence in transplant recipients.
- Examination of the relationship between immunosuppressive agents and cancer development.
Main Results:
- Cancer is more prevalent in solid-organ transplant recipients than the general population.
- Immunosuppression contributes to malignancy by promoting viral oncogenesis or reducing immune surveillance.
- Specific immunosuppressive drugs are linked to increased cancer risk, while others may offer protection.
Conclusions:
- Malignancy is a significant concern in kidney transplant recipients, impacting long-term survival.
- Understanding the interplay between immunosuppression and cancer is crucial for patient management.
- Further research into immunosuppressive strategies with lower oncogenic potential is warranted.
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