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Updated: Sep 5, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Transplant Onconephrology in Patients With Kidney Transplants
Naoka Murakami1, Allison B Webber2, Vinay Nair3
1Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract:
Cancer is a leading cause of death in patients with kidney transplantation. Patients with kidney transplants are 10- to 200-times more likely to develop cancers after transplant than the general population, depending on the cancer type. Recent advances in cancer therapies have dramatically improved survival outcomes; however, patients with kidney transplants face unique challenges of immunosuppression management, cancer screening, and recurrence of cancer after transplant. Patients with a history of cancer tend to be excluded from transplant candidacy or are required to have long cancer-free wait time before wait-listing. The strategy of pretransplant wait time management may need to be revisited as cancer therapies improve, which is most applicable to patients with a history of multiple myeloma. In this review, we discuss several important topics in transplant onconephrology: the current recommendations for pretransplant wait times for transplant candidates with cancer histories, cancer screening post-transplant, post-transplant lymphoproliferative disorder, strategies for transplant patients with a history of multiple myeloma, and novel therapies for patients with post-transplant malignancies. With emerging novel cancer treatments, it is critical to have multidisciplinary discussions involving patients, caregivers, transplant nephrologists, and oncologists to achieve patient-oriented goals.
Insights
Kidney transplant recipients face higher cancer risks and unique challenges. Revisiting pre-transplant wait times and enhancing post-transplant care are crucial for managing cancer in these patients.
Area of Science:
- Onconephrology
- Transplant medicine
- Oncology
Background:
- Cancer is a significant cause of mortality in kidney transplant recipients.
- These patients exhibit a 10- to 200-fold increased risk of developing various cancers post-transplant compared to the general population.
- Managing immunosuppression, cancer screening, and recurrence present unique challenges.
Purpose of the Study:
- To review current recommendations for pre-transplant cancer-free wait times.
- To discuss post-transplant cancer screening and management strategies.
- To explore novel therapies for post-transplant malignancies and specific considerations for multiple myeloma patients.
Main Methods:
- Literature review of transplant onconephrology topics.
- Analysis of current guidelines for cancer patients undergoing kidney transplantation.
- Discussion of challenges and advancements in managing malignancies in transplant recipients.
Main Results:
- Existing pre-transplant wait time strategies may require reevaluation due to improved cancer therapies, particularly for multiple myeloma.
- Post-transplant lymphoproliferative disorder and other malignancies necessitate tailored screening and treatment approaches.
- Multidisciplinary collaboration is essential for optimizing patient-centered care.
Conclusions:
- Optimizing cancer care in kidney transplant recipients requires a dynamic approach to wait time management and vigilant post-transplant surveillance.
- Advances in oncology necessitate updated protocols for managing cancer history in transplant candidates.
- Integrated care involving nephrologists, oncologists, and patients is vital for improved outcomes.
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