Kidney Transplant Recipients Have Higher Malignancy Prevalence Than Hemodialyzed Patients.

ABSTRACT

BACKGROUND: Kidney transplant is the preferred therapy for end-stage kidney disease; however, it has been associated with some serious complications, including malignancy, which became the second leading cause of death among kidney allograft recipients. The aim of this study was to assess the prevalence of malignancy in hemodialyzed patients and in kidney transplant recipients. METHODS: A cross-sectional study was conducted in 114 prevalent hemodialyzed patients, including 7 on the waiting list and 350 kidney allograft recipients. Hemodialyzed patients and kidney allograft recipients did not differ in regard to sex, dialysis vintage, and cause of end-stage renal failure, but were significantly older. RESULTS: Among wait-listed patients, only 1 had a history of malignancy (gastric cancer stage G1). Among kidney allograft recipients, in 70 patients, malignancy developed (in total 20% of the studied population). The leading malignancy was skin cancer (18 cases), followed by post-transplant lymphoproliferative disorder (PTLD) in 10 cases, lung cancer (small cell and non-small cell lung cancer; 4 cases), renal cell carcinoma (3 cases), brain cancer (glioma; 3 cases), colorectal cancer (3 cases), Kaposi sarcoma (2 cases), Merkel carcinoma (2 cases), metastatic disease of unknown origin (2 cases), and other 23 malignancies were in a single patient (including 1 leukemia and 1 multiple myeloma). Twenty-six deaths were recorded in kidney allograft recipients with malignancy, mainly in PTLD, Kaposi sarcoma, Merkel carcinoma, sarcoma, glioma, and melanoma. CONCLUSIONS: Despite the lower prevalence of malignancy on hemodialyzed population, cancer screening in both potential transplant recipients and kidney allograft recipients is a prerequisite, because nowadays there is a scarcity of data in this area. It may be due to previous immunosuppression, long-term dialysis vintage, immunocompromised status, and immunosuppressive therapy after transplant, in particular in high-risk patients.