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Renal cancer in kidney transplanted patients

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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.

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Acknowledgments

This paper was promoted by the “Onco-Nephrology Working Group” coordinated by Maurizio Gallieni under the auspices of the Italian Society of Nephrology (SIN), chaired by Giovanbattista Capasso and the Italian Association of Medical Oncology (AIOM), chaired by Stefano Cascinu.

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Authors and Affiliations

  1. Nephrology, Dialysis and Renal Transplantation Unit, Ospedali Riuniti, V. Conca 71, 60020, Ancona, Italy

    Giovanni M. Frascà & Emilio Balestra

  2. U.O. Nefrologia, Spedali Civili di Brescia, Brescia, Italy

    Silvio Sandrini & Chiara Salviani

  3. Nephrology and Dialysis Unit, Istituti Ospitalieri Cremona, Cremona, Italy

    Laura Cosmai

  4. Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy

    Camillo Porta

  5. Section of Nephrology, Department of Medicine, Yale School of Medicine and the Yale New Haven Transplantation Center, New Haven, CT, USA

    William Asch

  6. Clinica di Oncologia Medica-Università Politecnica delle Marche, Ancona, Italy

    Matteo Santoni

  7. “F. Addarii” Institute of Oncology and Transplantation Pathology, Bologna University, Bologna, Italy

    Antonia D’Errico & Deborah Malvi

  8. Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy

    Maurizio Gallieni

  9. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milano, Milan, Italy

    Maurizio Gallieni

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  1. Giovanni M. Frascà
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Frascà, G.M., Sandrini, S., Cosmai, L. et al. Renal cancer in kidney transplanted patients. J Nephrol 28, 659–668 (2015). https://doi.org/10.1007/s40620-015-0219-8

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