[Malignant tumors in bearers of kidney grafts in immunosuppressive therapy]

Out of 420 kidney transplant recipients at the University Hospital, Zurich, operated on between 1964 and 1978, 23 developed one or more malignant tumors. This corresponds to 5.8% of all patients. They included 8 cases of malignant lymphoma (non-Hodgkin), one of subacute myeloic leukemia, one of acute lymphatic leukemia, 6 skin cancers and 9 cancers of internal organs. Thirteen patients died, a figure corresponding to 8% of all deaths after kidney transplantation. Nine of the 10 patients with lymphoma and leukemia died, in 5 cases despite therapy. The response to therapy (radiotherapy and/or chemotherapy) was much poorer than in other patients with comparable tumors and in some patients completely absent. The only surviving patient (malignant lymphoma of the small bowel and the retroperitoneum) was treated by a combination of surgery, radiotherapy and chemotherapy and has had a symptom-free follow-up time of 3 1/2 years. The 6 skin cancers (4 of the spinocellular type) were excised. Recurrences were not noted. The visceral carcinomas (2 breast cancers, 1 carcinoma respectively of the pancreas, the rectum, the liver, the kidneys, the renal pelvis, and the urinary bladder, and one seminoma) were treated by generally accepted surgical principles as far as treatment of the patients was possible. The breast cancer and seminoma patients have survived thus far without recurrences or metastases.