Renal cancer in kidney transplanted patients

• Published in: Journal of nephrology Vol. 28; no. 6; pp. 659 - 668
• Main Authors: Frascà, Giovanni M., Sandrini, Silvio, Cosmai, Laura, Porta, Camillo, Asch, William, Santoni, Matteo, Salviani, Chiara, D’Errico, Antonia, Malvi, Deborah, Balestra, Emilio, Gallieni, Maurizio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2015
• Subjects: Calcineurin Inhibitors - therapeutic use; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - epidemiology; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - therapy; Early Detection of Cancer; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Kidney Diseases, Cystic - epidemiology; Kidney Neoplasms - diagnosis; Kidney Neoplasms - epidemiology; Kidney Neoplasms - mortality; Kidney Neoplasms - therapy; Kidney Transplantation - adverse effects; Kidney Transplantation - statistics & numerical data; Medicine; Medicine & Public Health; Nephrology; Polycystic Kidney, Autosomal Dominant - epidemiology; Review; TOR Serine-Threonine Kinases - antagonists & inhibitors; Urology; Renal transplantation; mTOR inhibitors; Immunosuppressive therapy; Renal cancer; Calcineurin inhibitors
• ISSN: 1121-8428; 1724-6059; 1724-6059
• DOI: 10.1007/s40620-015-0219-8

Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90 % of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.