Post-Transplant Cancer: Diagnostic and Therapeutic Management
Pp. 302-311 (10)
Giuseppe Giuffrida, Daniela Corona and Massimiliano Veroux
Abstract
Increasing success in organ transplantation, longer graft and patient survival malignancies
are becoming a major burden in transplantation medicine.
There is now convincing evidence to confirm a 3- to 5-fold increase in overall cancer incidence.
Duration and intensity of immunosuppression have been linked to the increased incidence of malignancies
and the choice of immunosuppressive therapy could also play a role in the development of cancer.
It is mandatory to understand how and when the tumoral process began and if a screening program
could be established. Considering the poor outcome of transplanted patients that develop a tumour
process, immunosuppression dose reduction or withdrawal is sometimes necessary to control
the progression of life-threatening malignancies maintaining, when possible, graft function.
A conversion from CNI to PSI, although is not curative, could be potentially helpful to prolong survival
in some patients. Transplant recipients with evidence of cancer should be offered the best medical and
surgical oncology treatment in addition to the choice of immunosuppressive therapy.
Those patients in whom the neoplastic process is advanced and life expectance is really poor probably
could not have any clinical advantage reducing or stopping immunosuppressive therapy, adding at
cancer disease the risk of acute rejection and graft loss.
Keywords:
Calcineurin Inhibitors, Immunosuppression, PSI, Kaposi, Cancer, Post-Transplant Cancer,
Sirolimus, Post-Transplant Screening, Everolimus, Lymphoproliferative Disorders.
Affiliation:
Department of Surgery, transplantation and Advanced Technologies, Vascular surgery and Organ Transplant Unit, University Hospital of Catania, Via Santa Sofia, 83, 95123 Catania, Italy
