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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 4  |  Page : 400-402
Malignancy in Renal Transplant Recipients at King Hussein Medical Center


Department of Nephrology, King Hussein Medical Center, Amman, Jordan

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   Abstract 

The files of 181 patients who underwent kidney transplantation at King Hussein Medical Center between 1983 and 1992 were reviewed to study the incidence and pattern of malignancy in them. Of them, 149 patients (82.3%) were recipients of live related donor allografts while 32 (17.7%) had received cadaveric allografts. Three patients (1.7%) developed malignancy giving an estimated annual incidence for post-transplant malignancy of 17/10,000 kidney transplanted patients. The first patient had squamous cell carcinoma of the nose, the second, Kaposi's sarcoma and the third, Non-Hodgkin's lymphoma involving the retroperitoneal lymph nodes. All these patients were on triple immunosuppressive drug protocol. The malignancies were diagnosed after a mean of 25.6 months following transplantation. The patient with squamous cell carcinoma responded to local excision of the tumor without altering the immunosuppressive therapy. The Kaposi's sarcoma regressed after discontinuation of cyclosporine without any adverse effects on the graft function while the patient with lymphoma died two months after the diagnosis was made. Our study shows that the incidence of malignancy after transplantation in Jordan is similar to what is reported in the literature.

Keywords: Malignancy, Renal transplantation, Jordan, Immunosuppression.

How to cite this article:
Al-Akash N, Gneimat M, Hadidi M, El Lozi M. Malignancy in Renal Transplant Recipients at King Hussein Medical Center. Saudi J Kidney Dis Transpl 1995;6:400-2

How to cite this URL:
Al-Akash N, Gneimat M, Hadidi M, El Lozi M. Malignancy in Renal Transplant Recipients at King Hussein Medical Center. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jan 21];6:400-2. Available from: http://www.sjkdt.org/text.asp?1995/6/4/400/40557

   Introduction Top


Long-term immunosuppressive therapy after organ transplantation is associated with an increased risk for the development of malignant disease. With the exception of pre-existing or undetected cases, most of the malignancies in graft recipients are de要ovo, developing at various periods following transplantation [1] . The reported incidence rates for the development of de-novo malig要ancies after renal transplantation ranges between 1 to 16% [2] . Immunosuppression promoting viral oncogenesis might be pro計osed as one possible explanation for the unusual profile of post-transplant malignancy [3] . The common types of de-novo malig要ancies that develop in transplant recipients are different from those occurring in the general population [4] . Since the number of kidney transplantations being performed in Jordan has increased rapidly in recent years, we reviewed the development of de-novo cancer in our renal transplant patients.


   Materials and Methods Top


Between January 1983 and December 1992, a total of 181 patients underwent kidney transplantation in Jordan at King Hussein Medical Center. Of them, 149 patients (82.3%) received live related donor allografts and 32 (17.7%) received cadaveric allografts.

The age of the patients at the time of transplantation ranged between 19 and 50 years and the follow-up period was between 12 and 84 months. There were 155 (85.6%) males and 26 (14.7%) females in the study. A total of 118 patients (65.2%) were on triple immunosuppressive therapy with cyclosporine (4-6 mg/kg/BW), azathioprine (2-3 mg/kg/ BW) and prednisolone (10 mg/day) while 63 patients (34.8%) were on azathioprine and prednisolone only. The diagnosis of malignancy was made on histopathological examination in all patients.


   Results Top


Three of the 181 (1.7%) study patients developed cancer post-transplant. This gives an estimated annual incidence of post-trans計lant malignancy in our study of 17/10,000 kidney transplanted patients. Two of these patients were males and one was female. The first patient, aged 44 years developed squamous cell carcinoma (SCC) of the nose, the second, aged 47 years developed Kaposi's sarcoma (KS) of the skin of his lower extremity while the third patient, aged 39 years developed Non-Hodgkin's lymphoma (NHL) (immunoblastic lymphoma) involving the retroperitoneal lymph nodes.

The time interval between performing the transplantation and diagnosis of cancer was 28 months for SCC, 30 months for KS, and 19 months for lymphoma. All these patients were on triple immunosuppressive regimen with cyclosporine, azathioprine, and steroids. Salient clinical manifestations of the three patients are given in [Table - 1].

The patient with SCC was subjected to local excision of the tumor without dis苞ontinuation of the immunosuppressive drugs. This patient did not develop recurrence after eight years of follow-up. In the patient with KS, cyclosporine was discontinued which was followed by a prompt disappear苔nce of the tumor within few weeks. The patient continued to have normal kidney function, without resuming cyclosporine until two years later when she died of hepatic coma of unrelated cause. The patient with immunoblastic lymphoma died within two months after the diagnosis.


   Discussion Top


The increased risk of development of malignant disease in immunosuppressed population has been well recognized in recent years. Lymphomas, skin cancer and KS are among the most common malignancies that occur in these individuals [5] . In our study, the estimated incidence of post負ransplant malignancy is 17/10,000 kidney transplanted patients. This is higher than that reported among the general population in Jordan; 1.8/ 100,000 for Non-Hodgkin's lymphoma and 0.1/100,000 for skin cancer [6] .

The majority of post-transplant lymphomas are of the Non-Hodgkin's type in contrast to only 65% seen in the general population [5] . About 51% of the patients have involvement of multiple organs or sites while in the remaining 49% the disease is confined to a single organ or site. There is a higher incidence of extranodal involvement in transplant recipients than in their counterparts in the general population. Involvement of the central nervous system (CNS) is seen in 28% of cases among transplant recipients compared with only 1% involvement in the general population. In 63% of cases with CNS involvement, the lesions are confined to the brain whereas in the general population cerebral lymphomas are frequently associated with involvement of other organs [7] .

Of the skin cancers, the greatest increase is seen for SCC which has been shown to outnumber basal cell carcinoma by 1.8 :1 while in the general population the ratio of SCC to basal cell carcinoma is 1:5 [8] . It has been shown that SCC occurs at a much younger age, the incidence of multiple skin cancers is higher and SCC is more aggressive in the transplant ecipients than that seen in the general population [8] .

Kaposi's sarcoma is well recognized in patients with immunodeficiency states such as organ transplantation, malignancy and acquired immunodeficiency syndrome [9],[10] . It is a multicentric vascular neoplasm of mesenchymal pluripotent cell origin and presents in two forms: the benign cutaneous nodular form and the invasive malignant form associated with ulcerating skin tumor, lymphadenopathy and visceral involvement [10] . There is a high incidence of KS in allograft recipients of Jewish and Mediter訃anean ancestry in North America and Western Europe [11] .

However, malignancies commonly seen in the general population such as those involving the prostate, lung, colon and breast are not seen with increased frequency in transplant recipients [11] .


   Conclusion Top


The present study shows that the incidence in our patients is about the same as reported in the Western literature. Reduction or discontinuation of immunosuppressive drugs,particularly cyclosporine, may be adequate for localized KS while for the other forms of cancer, the surgical approach is similar to that applied in the general population.

 
   References Top

1.Wu MS, Huang CC, Chu SH, Chuang CK, Lai MK. Malignancy in renal transplant recipients. Transplant Proc 1992;24(4): 1591-3.  Back to cited text no. 1    
2.Kinlen LJ, Sheil AG, Peto J, Doll R. Collaborative United Kingdom耍ustralasian study of cancer in patients treated with immunosuppressive drugs. Br Med J 1979;2:1461-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Frei U, Bode U, Repp H, et al. Malignancies under cyclosporine after kidney transplantation: analysis of a 10軌ears period. Transplant Proc 1993;25(l):1394-6.  Back to cited text no. 3    
4.Gruber SA, Skjei KL, Sothern RB, et al. Cancer development in renal allograft recipients treated with conventional and Cyclosporine immunosuppression. Transplant Proc 1991;23(1): 1104-5.  Back to cited text no. 4    
5.Penn I. The changing pattern of post transplant malignancies. Transplant Proc 1991;23(1): 1101-3.  Back to cited text no. 5    
6.Kamal MF. Cancer patterns in Jordan 1975-1979. Ann Chir Gynaecol 1987;76:191-6.  Back to cited text no. 6  [PUBMED]  
7.Chu SH, Lai MK, Huang CC, Chuang CK. Lymphoma in cyclosporine treated renal transplant recipients. Transplant Proc 1992;24(4):1594-5.  Back to cited text no. 7    
8.Blohme L, Larko O. No difference in skin cancer incidence with or without cyclosporine - a 5 year perspective. Transplant Proc 1992;24(1):313.  Back to cited text no. 8    
9.Safai B, Good RA. Kaposi's sarcoma: a review and recent developments. Clin Bull 1980;10:62-9.  Back to cited text no. 9  [PUBMED]  
10.Friedman Kien AE. Disseminated Kaposi's sarcoma syndrome in young homosexual men. J Am Acad Dermatol 1981;5:468-71.  Back to cited text no. 10    
11.Penn I. Tumor incidence in human allograft recipients. Transplant Proc 1979;11:1047-51.  Back to cited text no. 11  [PUBMED]  

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Correspondence Address:
Nabil Al-Akash
Department of Nephrology, King Hussein Medical Center, P.O. Box 960955, Amman
Jordan
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PMID: 18583747

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    Abstract
    Introduction
    Materials and Me...
    Results
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