Genitourinary malignancies in organ transplant recipients

The current recommendations for management of patients with pre-existing neoplasms before transplantation is a function of the cure rate achieved with the available therapeutic modalities and the risk of recurrence following initiation of immunosuppression. Recurrences after transplantation, as well as de novo malignancies, although unpredictable in many cases, have been identified as arising in certain individuals at risk and are a result of multifactorial etiologies. These etiologies include oncogenic effects of immunosuppressive agents or their broken-down metabolites, depressed immunity, dampened immune response, and activation of oncogenic viruses (herpes group, EBV), carcinogens, congenital predilection, and dormant residual cancers of high malignant potentials. Better understanding of the interplay of these factors and longer follow-up of transplant recipients receiving contemporary immunosuppressive agents are needed in order to diminish the likelihood of tumor recurrence/development in this population. Judicious application of current information obtained from the transplant registries, better understanding of immunosuppressive agents and their long-term oncogenic effects, and careful and conscientious allocation of cadaveric organs are advised.