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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Clinical management of cancer after kidney transplantation
Takahisa Hiramitsu1, Ayano Ienaga1, Yuki Shimamoto1
1Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Abstract:
Advances in immunosuppressive therapy have markedly improved short-term graft survival post-kidney transplantation (KT); however, these advances have also profoundly altered long-term disease patterns in transplant recipients. Cancer remains a major barrier limiting improvements in long-term survival. Kidney transplant recipients are at increased risk of malignancy owing to impaired graft function and immunosuppressive medications. To improve cancer-related outcomes, comprehensive strategies encompassing prevention, early detection through screening, and appropriate treatment are required. Primary prevention includes the appropriate selection and maintenance of immunosuppressive medications, careful consideration of KT indications for recipients and donors with previously treated cancers, and vaccination. Secondary prevention requires effective, risk-adapted cancer screening in high-risk kidney transplant recipients. Following a cancer diagnosis, management includes localized resection and systemic therapy for primary, recurrent, or refractory disease. Systemic therapy includes chemotherapy and immunotherapy, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, which may affect graft function and cause treatment-specific adverse effects. Additionally, immunosuppressive medications often require modification to minimize the risk of graft rejection while maintaining a low likelihood of recurrence. In this review, we summarize current strategies for cancer prevention, screening, and treatment following KT.
Insights
Kidney transplant recipients face increased cancer risks due to immunosuppression. This review outlines essential strategies for cancer prevention, early screening, and treatment to improve long-term survival in these patients.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Immunosuppressive therapy improves kidney transplant (KT) graft survival but increases malignancy risk.
- Cancer is a significant factor limiting long-term survival in KT recipients.
- Impaired graft function and immunosuppressive drugs contribute to higher cancer incidence.
Purpose of the Study:
- To review current strategies for cancer prevention, screening, and treatment in kidney transplant recipients.
- To highlight the importance of comprehensive cancer management in this population.
- To discuss the impact of novel therapies on graft function and recurrence risk.
Main Methods:
- Literature review of current practices in cancer management post-kidney transplantation.
- Analysis of primary and secondary prevention strategies.
- Summary of treatment modalities including surgery, chemotherapy, and immunotherapy.
Main Results:
- Primary prevention involves judicious immunosuppression, donor/recipient cancer history evaluation, and vaccination.
- Secondary prevention emphasizes risk-adapted cancer screening for high-risk KT patients.
- Cancer treatment requires tailored approaches, including modified immunosuppression to balance rejection and recurrence risks.
Conclusions:
- Comprehensive cancer management, including prevention, screening, and treatment, is crucial for improving long-term outcomes in kidney transplant recipients.
- Novel immunotherapies require careful consideration regarding their impact on graft function.
- Optimizing immunosuppressive strategies is key to managing cancer recurrence risk while preserving graft health.
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