TY - JOUR
T1 - Renal cancer in kidney transplanted patients
AU - Frascà, Giovanni M.
AU - Sandrini, Silvio
AU - Cosmai, Laura
AU - Porta, Camillo
AU - Asch, William
AU - Santoni, Matteo
AU - Salviani, Chiara
AU - D’Errico, Antonia
AU - Malvi, Deborah
AU - Balestra, Emilio
AU - Gallieni, Maurizio
PY - 2015/12/1
Y1 - 2015/12/1
N2 - 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.
AB - 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.
KW - Calcineurin inhibitors
KW - Immunosuppressive therapy
KW - mTOR inhibitors
KW - Renal cancer
KW - Renal transplantation
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U2 - 10.1007/s40620-015-0219-8
DO - 10.1007/s40620-015-0219-8
M3 - Article
C2 - 26202137
AN - SCOPUS:84944186143
VL - 28
SP - 659
EP - 668
JO - Journal of Nephrology
JF - Journal of Nephrology
SN - 1121-8428
IS - 6
ER -