CANCERS AFTER TRANSPLANTATION

One of the main reasons why transplant patients die after they have received a transplant is because they are at a higher risk compared to the general population for getting different cancers. It has been estimated that cancers is one of the top three reasons, after heart disease and infections, of recipient demise after a successful transplant. Risk of developing cancer is 2 to 3 times more in a transplant recipient compared to the general population, with younger recipients at a higher risk than older recipients. For example, children are at a 15-30 times higher risk of cancer development compared to older adults.

There are reports of cancers being unknowingly transmitted from a donor to the recipient. These include cancers of the breast, uterus, colon, brain , liver , lung , lymphoma, melanoma, ovary, pancreas prostate, kidney and thyroid.

Why are transplant patients prone to developing cancers?

This is generally because of a complex interplay of various factors that includes:

1. the organ transplanted
2. prior and new exposure to different viruses
3. anti -rejection medications – how much and for how long
4. specific components of different anti-rejection drugs
5. increased risk of cancer who have specific organ failure requiring a transplant

What are the specific cancers that transplant recipients are prone to getting?

These include:

1. Non-melanoma skin cancers and lip cancers (> 10 fold increase), decreased risk in black population because of skin pigmentation
2. Non-Hodgkin lymphoma (> 8 fold)
3. Kaposi sarcoma (> 50 fold)
4. Cancers of the ano-genital tract – vaginal, cervical, vulval, anal and penile cancers

Other less common sites include colorectal cancer, melanoma  and lung cancer. Cancers that do not increase in risk are breast and prostate cancer.

What are the treatment options if cancers develop after a transplant?

Several options, including conventional treatments such as surgery, chemotherapy and radiation therapy are considered, depending on the type of cancer.

For kidney transplant patients, reducing or stopping immunosuppression and returning to dialysis is a consideration. The cancer can then be treated with conventional methods.

In liver transplant patients, switching medications that have less potential to cause cancers or re-transplantation are options.

Every case should have individualized treatment after thorough evaluation by the oncologist and the transplant team.