Renal cancer in kidney transplanted patients

Giovanni M. Frascà, Silvio Sandrini, Laura Cosmai, Camillo Porta, William Asch, Matteo Santoni, Chiara Salviani, Antonia D’Errico, Deborah Malvi, Emilio Balestra, Maurizio Gallieni

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)659-668
Number of pages10
JournalJournal of Nephrology
Volume28
Issue number6
DOIs
Publication statusPublished - Dec 1 2015

Keywords

  • Calcineurin inhibitors
  • Immunosuppressive therapy
  • mTOR inhibitors
  • Renal cancer
  • Renal transplantation

ASJC Scopus subject areas

  • Nephrology

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