Abstract
Cancer occurs in immunosuppressed transplant recipients when organs are transplanted from donors dying of cancer. Cancer also occurs spontaneously in transplant recipients with an overall frequency 4 times that of the age-matched general population. In patients treated with azathioprine and steroids, 14% of those who survive for 15 years after the transplant will have cancer other than skin cancer and, in areas “high risk” for skin cancer, 44% will have malignant lesions of the skin. With non-skin malignancies, 40% have an association, perhaps causal, with viral infections. These include cancers of the reticuloendothelial system, leukemia, hepatoma, and cancers of the lips, vulva, cervix, and anus. Of these, most are reticuloendothelial malignancies which comprise 30% of all non-skin cancers. Within this group reticulum cell sarcomas predominate, often with involvement of the central nervous system. The most common malignancies are cancers of the skin. Squamous cell carcinoma is the most frequent lesion and these cancers tend to be multiple, aggressive, and recurrent. Significant numbers metastasize and some patients die of squamous cell carcinoma. Malignant melanoma is also occurring with increased frequency. Malignancies occur virtually from the time of transplantation with an increased risk of developing malignancy continuing indefinitely. Average time for appearance of all cancers is 4–5 years after transplantation. Patients with malignancy treated before transplantation are at increased risk of developing malignancy after transplantation. Clinicians must have a high index of suspicion with regard to cancer development in immunosuppressed transplant recipients. Many such cancers can be cured if diagnosed early and treated effectively. Otherwise, prognosis is poor since cancers that develop in these patients are aggressive.
Résumé
Le cancer se manifeste chez le transplanté immunodéprimé quand l'organe transplanté provient d'un donneur porteur d'une tumeur maligne mais il survient aussi spontanément 4 fois plus souvent chez les transplantés que dans la population normale alors même que les donneurs sont sains. Chez les sujets traités par l'azathioprine et les stéroides 14% de ceux qui survivent plus de 15 ans présenteront des cancers autres que cutanés et dans les zones propices au cancer cutané 44% présenteront des lésions malignes de la peau. Il a été noté chez les sujets qui présentent des cancers autres que cutanés la présence d'une infection virale associée, facteur déterminant possible, dans 40% des cas. Ces cancers revêtent divers types: cancer du système réticulo-endothélial, leucémie, hépatome, cancer des lèvres, de la vulve, du col utérin, de l'anus. Dans ce groups le taux du cancer réticuloendothélial atteint 30%; le plus souvent il revêt un type sarcomateux et concerne le système nerveux central. Les cancers les plus fréquents sont cependant les cancers cutanés. Le plus souvent de type squameux, ils ont tendance à être multiples, invasifs, et récidivants. Ils donnent lieu souvent à des métastases et peuvent entraîner la mort. Les mélanomes également sont fréquents. Le processus néoplasique débute virtuellement dès la transplantation et tend à se développer de manière continue et progressive pour se manifester en moyenne 4 à 5 ans après la transplantation. Les sujets transplantés qui ont été traités pour un cancer avant la transplantation sont particulièrement exposés au développement d'un nouveau processus malin. Les cliniciens doivent être particulièrement prévenus de ce risque considérable chez le sujet transplanté immunodéprimé, de manière à le détecter rapidement et à le traiter efficacement. Tout retard se solde par un mauvais pronostic en raison du caractère rapidement invasif du processus tumoral.
Resumen
El cáncer se presenta en los recipientes inmunosuprimidos de transplantes cuando se transplantan órganos de pacientes que mueren de cáncer. El cáncer tambien ocurre espontáneamente en recipientes de transplantes con una frecuencia global 4 veces mayor que en el resto de la población general del mismo grupo etáreo. En los pacientes tratados con azatioprina y esteroides, 14% de aquellos que sobreviven por más de 15 años después del transplante desarrollan cáncer diferente del cáncer cutáneo, y en áreas geográficas de “alto riesgo” de cáncer cutáneo 44% desarrollan lesiones malignas de la piel. Con neoplasias malignas no cutáneas, 40% exhiben asociación, tal vez causal, con infecciones virales. Tales neoplasias incluyen lesiones del sistema reticuloendotelial, leucemia, hepatoma y cánceres del labio, vulva, cervix y ano. De estas, la mayoría son neoplasias reticuloendoteliales, las cuales constituyen el 30% de los cánceres no cutáneos. Dentro de tal grupo predominan los sarcomas reticulocelulares, con frecuencia con afección del sistema nervioso central. Las neoplasias malignas más frecuentes son los cánceres de la piel. El carcinoma escamocelular es la lesión más común; tiende a ser múltiple, agresivo y recurrente. Un número significativo produce metástasis y algunos pacientes mueren por este tipo de tumor. El melanoma maligno también está apareciendo con frecuencia creciente. Las neoplasias malignas se pueden presentar virtualmente desde el momento del transplante, y el riesgo aumentado de desarrollar tales neoplasias continúa en forma indefinida. El tiempo promedio para la aparición de estos cánceres es de 4–5 años después del transplante. Los pacientes con neoplasias malignas tratados antes de transplante tienen, con frecuencia creciente, riesgo de desarrollar neoplasias malignas después de transplante. El médico debe mantener un alto índice de sospecha en relación al desarrollo de cáncer en los recipientes inmunosuprimidos de transplantes. Muchos de estos cánceres pueden ser curados con un diagnóstico precoz y un tratamiento efectivo. De lo contrario el pronóstico es pobre, por cuanto los cánceres que se presentan en este tipo de paciente son de característica agresividad.
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Ross Sheil, A.G. Cancer after transplantation. World J. Surg. 10, 389–396 (1986). https://doi.org/10.1007/BF01655298
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DOI: https://doi.org/10.1007/BF01655298