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High posttransplant cancer incidence in renal transplanted patients with pretransplant cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
department of Transplant Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
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2017 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 101, no 6, p. 1295-1302Article in journal (Refereed) Published
Abstract [en]

Background. Patients with previous cancer have increasingly been accepted for renal transplantation. Posttransplant cancer risk and survival rates of these patients are unknown. Our objective was to assess the risk of posttransplant cancer in this patient group. Methods. In this retrospective, nested case-control study, we assessed the outcome of all (n = 95) renal transplanted patients with pretransplant cancer diagnoses in the Uppsala-Orebro region, Sweden. The control group was obtained from the Collaborative Transplant Study registry and included European patients without pretransplant cancer. The other control group comprised the entire renal transplanted population in Uppsala. Development of recurrent cancer, de novo cancer, and patient survival were determined. Results. Patients with pretransplant cancer showed higher incidence of posttransplant cancers and shorter survival compared with the control groups (P < 0.001). No obvious pattern in malignant diagnoses was observed. Death-censored graft survival was unaffected. Conclusions. Despite previously adequate cancer treatments and favorable prognoses, almost half of the patients experienced a posttransplant cancer. These observations do not justify abstaining from transplanting all patients with previous malignancies, because more than 50% of the patients survive 10 years posttransplantation. A careful oncological surveillance pretransplant as well as posttransplant is recommended.

Place, publisher, year, edition, pages
2017. Vol. 101, no 6, p. 1295-1302
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-282111DOI: 10.1097/TP.0000000000001225ISI: 000401835800026PubMedID: 27163539OAI: oai:DiVA.org:uu-282111DiVA, id: diva2:916456
Available from: 2016-04-02 Created: 2016-04-01 Last updated: 2017-07-04Bibliographically approved
In thesis
1. The clinical perspective on malignancies in renal transplanted patients
Open this publication in new window or tab >>The clinical perspective on malignancies in renal transplanted patients
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Post-transplant malignancies cause significant morbidity and mortality. In this thesis we investigated malignancies in renal transplanted patients from a clinical viewpoint. The use of regional tumour registries considerably improved identification of pre- and post-transplant malignancies, which are generally underreported in transplant registries.

Despite previously adequate cancer treatments with favourable prognosis, patients with pre-transplant malignancies showed higher incidence of post-transplant cancer and reduced survival compared to a 1:3 ratio matched control group of patients without a previous cancer from the Collaborative Transplant Study in Europe. A careful oncological surveillance pre-transplant and post-transplant is recommended.

A multidisciplinary team evaluated the immunosuppressive and oncological treatment in a clinical prospective observational study of 120 renal transplanted patients with post-transplant malignancies. In two-thirds of the patients immunosuppression was possible to change to mTOR inhibitors with anti-tumour effects. Oncological treatment was adjusted in 50% of patients with solid or haematological tumours. MDT assessments are essential for optimizing treatment of post-transplant malignancies.

Number of previous cutaneous squamous cell carcinoma (SCC) posed the most significant risk variable in predicting subsequent SCCs during a two-years study of 73 transplanted patients with at least one SCC.

Incidence of transplant-derived tumours is 5 times higher than anticipated. Three of eleven cancers in urinary tract and two of four cancers in the transplants were transplant-derived. Five of eleven cancers of the urinary tract were BK-virus positive. Allograft immune response against these tumours offer new options for cancer treatment such as immunomodulatory or anti-viral treatment in combination with modified immunosuppression.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1210
Keyword
renal transplantation, malignant tumours
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282131 (URN)978-91-554-9549-7 (ISBN)
Public defence
2016-06-04, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-05-13 Created: 2016-04-02 Last updated: 2016-06-01

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Hellström, VivanLorant, TomasTufveson, GunnarEnblad, Gunilla

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