Solid organ transplantation has been an accepted mode of therapy for the treatment of end-stage organ diseases for many years. Recipients' survival, however, has been hindered by organ rejection and the comorbid diseases that develop as a result of immunosuppressive therapy. In particular, organ transplant recipients have an increased risk of developing cancer de novo after transplantation. Prevalence ranges from 4 to 18% with an average incidence of 6%. Data submitted to the Cincinnati transplant tumor registry have revealed that cancers prevalent in the general population exhibited no increase in rate and may even show a slight decline in the transplant population. Length of survival after transplantation is associated with the likelihood of having cancer; the longer the recipient survives, the greater the chance. The actuarial risk among 124 cardiac transplant recipients was 2.7+/-1.9% at 1 year and 25.6+/-11% at 5 years. This article will review the current literature on the incidence and treatment of cancer in solid organ transplant recipients.
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References
1.
PennI. Depressed immunity and the development of cancer. Cancer Detect Prev.1994;18:241–252.
2.
PennIHammondWBrettschneiderL. Malignant lymphomas in transplantation patients. Transplant Proc.1969;1:106–111.
3.
KaySFrableWJHumeDM. Cervical dysplasia and cancer developing in women on immunosuppressive therapy for renal homotransplantation. Cancer.1970;26:1048–1052.
4.
PennI. Sarcomas in organ allograft recipients. Transplantation.1995;60:1485–1491.
5.
PennI. Occurrence of cancers in immunosuppressed organ transplant recipients. In: TerasakiPI, ed. Clinical Transplants.Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1990:53–62.
6.
PennI. Incidence and treatment of neoplasia after transplantation. J Heart Lung Transplant.1993;12(pt 2):S328–S335.
7.
PennIBrunsonME. Cancers after cyclosporine therapy. Transplant Proc.1988;20(suppl 3):885–892.
8.
PennI. Cancer in cyclosporine-treated versus azathioprinetreated patients. Transplant Proc.1996;28:876–878.
9.
PennI. Tumors after renal and cardiac transplantation. Hematol Oncol Clin North Am.1993;7:431–445.
10.
BavinckBouwes JN. Epidemiological aspects of immunosuppression: Role of exposure to sunlight and human papillomavirus on the development of skin cancer. Hum Exp Toxicol.1996;27:154–164.
11.
BavinkBouwes JNGissmannLClaasFH. Relation between skin cancer, humoral responses to human papillomaviruses, and HLA class II molecules in renal transplant recipients. J Immunol.1993;151:1579–1586.
12.
StegerGOlszewskyMStockflethE. Prevalence of antibodies to human papillomavirus type 8 in human sera. J Virol.1990;64:4399.
13.
ShamaninVzur HausenHLavergneD. Human papillomavirus infections in nonmelanoma skin cancers from renal transplant recipients and nonimmunosuppressed patients. J Natl Cancer Inst.1996;88:802–811.
14.
PennI. Malignant melanoma in organ allograft recipients. Transplantation.1996;61:274–278.
15.
PennI. Cancers complicating organ transplantation. N Engl J Med.1990;323:1767–1769.
16.
WilkinsonAHSmithJLHunsickerLG. Increased frequency of posttransplant lymphomas in patients treated with cyclosporine, azathioprine, and prednisone. Transplantation.1989;47:293–296.
17.
SwinnenLJCostanzo-NordinMRFisherSG. Increased incidence of lymphoproliferative disorder after immunosuppression with the monoclonal antibody OKT3 in cardiac transplant recipients. N Engl J Med.1990;323:1723–1728.
18.
SwinnenLJFisherSGFisherRI. Elimination of OKT3 induction therapy; impact on the incidence of lymphoma following cardiac transplantation. Abstract presented at: International Society of Heart and Lung Transplantation Society 14th Annual Meeting and Scientific Session; March 23–26, 1994; Venice, Italy.
19.
HantoDWFrizzeraGGajl-PeczalskaKJSimmonsRL. Epstein-Barr virus, immunodeficiency, and B cell lymphoproliferation. Transplantation.1985;39:461–468.
20.
SeidenMVSklarJ. Molecular genetic analysis of posttransplant lymphoproliferative disorders. Hematol Oncol Clin North Am.1993;7:447–465.
21.
ArmitageJMKormosRLStuartRS. Posttransplant lymphoproliferative disease in thoracic organ transplant patients: Ten years of cyclosporine-based immunosuppression. J Heart Lung Transplant.1991;10:877–886.
22.
WalkerRCPayaCVMarshallWF. Pretransplantation seronegative Epstein-Barr virus status is the primary risk factor for posttransplantation lymphoproliferative disorder in adult heart, lung, and other solid organ transplantation. J Heart Lung Transplant.1995;12:214–221.
23.
HarwoodAROsobaDHofstaderL. Kaposi's sarcoma in recipients of renal transplants. Am J Med.1979;67:759–765.
24.
ShepherdFAMaherECardellaC. Treatment of Kaposi's sarcoma after solid organ transplantation. J Clin Oncol.1997;15:2371–2377.
25.
GoldsteinDJAustinJHZuechN. Carcinoma of the lung after heart transplantation. Transplantation.1996;62:772–775.
26.
BenkerrouMDurandyAFischerA. Therapy for transplantrelated lymphoproliferative diseases. Hematol Oncol Clin North Am.1993;7:467–475.
27.
WuTSwerdlowSHLockerJ. Recurrent Epstein-Barr virus-associated lesions in organ transplant recipients. Hum Pathol.1996;27:157–164.
28.
NalensnikMAMakowkaLStarzlTE. The diagnosis and treatment of posttransplant lymphoproliferative disorders. Curr Probl Surg.1988;25:371–472.
29.
The American Cancer Society. Cancer Facts and Figures 1997.Atlanta, Ga: The American Cancer Society; 1997.
30.
PetersonR. An emerging cancer risk: Organ transplantation. Cancer Nurs.1993;16:468–472.
