Renal cancer in kidney transplanted patients

Area of Science:

• Nephrology
• Oncology
• Transplantation Medicine

Background:

• Renal cancer incidence is elevated in kidney transplant recipients compared to the general population.
• Malignancy risk is influenced by immunosuppressive therapy, dialysis duration, and specific kidney conditions like acquired cystic kidney disease.

Purpose of the Study:

• To review risk factors and management strategies for renal cancer in kidney transplant patients.
• To evaluate the role of immunosuppressive agents, specifically calcineurin inhibitors (CNI) versus mammalian target of rapamycin (mTOR) inhibitors, in renal cancer development post-transplantation.

Main Methods:

• Review of existing literature on renal cancer in transplant recipients.
• Analysis of risk factors including immunosuppression, dialysis history, and pre-existing kidney diseases.
• Discussion of diagnostic and management approaches, including imaging and immunosuppression adjustment.

Main Results:

• Renal cancer affects native kidneys in 90% and grafts in 10% of transplant patients.
• Calcineurin inhibitors (CNI) and longer dialysis duration are associated with increased cancer risk.
• Acquired cystic kidney disease is a risk factor, while autosomal dominant polycystic kidney disease is not.

Conclusions:

• Annual ultrasound screening is advised for patients with cystic kidney disease or those over 60 with a significant dialysis history pre-transplant.
• Reducing or withdrawing CNI therapy is recommended upon diagnosis of renal cancer.
• Switching from CNI to mTOR inhibitors like everolimus or sirolimus may be beneficial, with caution in chronic allograft nephropathy.