Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2421 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1044-1047
Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation


1 Kidney Transplantation Center, Babol University of Medical Sciences, Babol, Iran
2 Kidney Transplantation Center, Babol University of Medical Sciences, Babol; Research and Technology Department, Mazandaran University of Medical Sciences, Manzadaran, Iran

Click here for correspondence address and email

Date of Web Publication4-Nov-2010
 

   Abstract 

Long-term immunosuppressive therapy after renal transplantation increases the risk of developing malignancy. The aim of this study was to determine the demographic parameters and immunosupression protocol in kidney transplant recipients with and without malignancy. This case-control study was undertaken on 12 renal transplant recipients with malignancy and 48 with­out malignancy at The Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Data including age, gender, number of anti-rejection therapies and immunosupression regimen were recorded and analyzed with SPSS and Mann-Whitney Fisher's exact t-test. P value < 0.05 was considered significant. The prevalence of malignancy in 380 renal allograft recipients was 3.15% during six years of follow-up. The malignancies noted after renal transplantation included: Kaposi's sarcoma (n = 5), lymphoma (n = 3), cutaneous basal cell carcinoma (n = 2), cutaneous squamous cell carcinoma (n = 1) and brain tumor (n = 1). Age of patients at the time of trans­plantation, duration of immunosupression treatment and number of anti-rejection therapies were not significantly different in patients with and without malignancy (P > 0.05). Males were signi­ficantly more affected with malignancy compared to females (P < 0.05). Our study shows that there was no significant correlation between age at transplantation, duration of immunosupression treatment and number of anti-rejection therapies and occurrence of post-renal transplantation malignancy; however, the prevalence of malignancy was significantly higher in male patients. The most common malignancy seen was Kaposi's sarcoma followed by lymphoma.

How to cite this article:
Akbarzadehpasha A, Oliaei F, Asrari M, Alizadeh-Navaei R. Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation. Saudi J Kidney Dis Transpl 2010;21:1044-7

How to cite this URL:
Akbarzadehpasha A, Oliaei F, Asrari M, Alizadeh-Navaei R. Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Aug 24];21:1044-7. Available from: http://www.sjkdt.org/text.asp?2010/21/6/1044/72289

   Introduction Top


Recipients of kidney transplants are more sus­ceptible to develop cancer. [1],[2],[3] This high inci­dence has been attributed to the use of immu­nosuppressive agents to prevent allograft re­jection. [4] The incidence of neoplasms among transplant recipients is increasing, being esti­mated between 4 and 18%. [5] Neoplasms sho­wing increased frequency in this group include: skin cancer, non-Hodgkin's lymphoma, Kaposi's sarcoma, in situ carcinoma of the uterine cer­vix, anogenital cancer, renal cell carcinoma, hepatocellular carcinoma and a variety of sar­comas. [4],[6],[7] Some well-known factors associa­ted with the development of tumors are genetic factors, smoking, chronic opportunistic infec­tion by oncogenic viruses, older age at trans­plantation, male gender and long-term immuno­suppression. The prevalence of neoplastic di­sease has been reported to be four to five times higher than that in the general population of similar age and gender distribution. [5],[8],[9] In this study, we reviewed some features of malig­nancies in renal transplant recipients in the north of Iran.


   Materials and Methods Top


This is a case-control study. A total of 380 patients underwent renal transplantation from 1999 to 2005 at the Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Of them, we analyzed 12 patients with post­transplant malignancy in the case-group and 48 patients without malignancy in the control­group. The control group was selected randomly among recipients of living donor transplants who had normal graft function and had com­pleted at least one year after transplantation. Data including age, gender, number of anti­rejection therapies and immunosupression re­gimen were recorded from medical records and analyzed with SPSS 11 and t-test, Mann­Whitney and Fisher's exact tests. P < 0.05 was considered significant.


   Results Top


The prevalence of malignancy in the 380 re­nal allograft recipients studied was 3.15% after six years of follow-up. The malignancies noted included: Kaposi's sarcoma (n = 5), lymphoma (n = 3), basal cell carcinoma (BCC) (n = 2), squamous cell carcinoma (SCC) (n = 1) and brain tumor (n = 1). The mean (± SD) age at transplantation was not significantly different in patients with (49.5 ± 13.3 years), and with­out malignancy (41.1 ± 14.3 years) (P = 0.073). The proportion of males in the malignant pa­tients group (11 males and 1 female) was sig­nificantly higher (P = 0.02) than in the non­malignant subject group (26 males and 22 females).

Duration of immunosupression treatment was not significantly different in patients with and without malignancy (51.4 ± 23.9 months vs 44.2 ± 24.3 months) (P > 0.05). Number of anti-rejection therapies administered was 1.08 ± 0.79 in patients with malignancy and 0.7 ± 0.84 in patients without malignancy (P > 0.05).

Ten subjects in the malignancy group and 42 subjects in the control group had received cyclosporine, prednisolone and azathioprine and two subjects in the malignancy group and six subjects in the control group had received cyclosporine in combination with prednisolone and mycophenolate mofetil (MMF) (P > 0.05). [Table 1] shows that anti-rejection therapy was not significantly different between the two groups (P > 0.05).
Table 1 :Frequency of anti-rejection medication between malignant and non-malignant subjects after kidney transplantation.

Click here to view



   Discussion Top


Malignancies are an important cause of mor­bidity and mortality among transplant recipients. The prevalence of malignancy in transplant recipients at our center was 3.15% while it was 1.8% in the study of Nafar et al from Iran, [4] 5.8% in the report of Altaee et al from Iraq, [10] 3% reported by Rascente et al from Italy, [5] 10.9% reported by Marcen et al from Spain [11] and 1.5% in the Tang et al study from China. [12] The findings of our study and that of Nafar et al show that the prevalence rate of post-kidney transplant malignancy was lower in Iran than elsewhere. One possible explanation for this finding is the preponderance of living donor kidney transplant recipients in our report, re­quiring low doses of immunosuppression. In addition, geographical influence and duration of follow-up post-transplantation might be res­ponsible for this difference.

The most common malignancy in the present study was Kaposi's sarcoma, which is similar to the reports of Nafar et al [4] and Altaee et al; [10] however, in other studies, skin cancers were the most frequent. [11],[13],[14],[15]

Age is one of the major risk factors for ma­lignancy after transplantation and in the pre­sent study, the mean age of recipients at the time of transplantation was higher in the ma­lignant group than in the non-malignant group, although this difference was not significant. The Italian registry of organ transplant reci­pients reported a nine-fold increase of skin cancer in transplanted patients above 50 years of age in comparison with those transplanted before 30 years of age. Also, a two-fold in­crease was seen in transplanted males versus females. [16] In the present study, the proportion of males in the malignant group was signi­ficantly higher than in the non-malignant group, which is in agreement with the results of Marcen. [11]

The mean duration of immunosuppressive therapy and number of anti-rejection therapies was higher in the malignant group than the non-malignant group but the difference was not statistically significant.


   Conclusion Top


Our report suggests that the prevalence of post-transplant malignancy is lower in Iran when compared with other countries and may be related to the high prevalence of living do­nor kidney transplants. Kaposi's sarcoma was the most frequently encountered malignancy.


   Acknowledgment Top


The authors wish to thank the kidney trans­plantation ward personnel for collaboration in this study.

 
   References Top

1.Winter P, Schoeneich G, Miersch WD, Klehr HU. Tumour induction as a consequence of immunosuppression after renal transplantation. Int Urol Nephrol 1997;29(6):701-9.  Back to cited text no. 1
    
2.Catena F, Nardo B, Liviano d'Arcangelo G, et al. De novo malignancies after organ trans­plantation. Transplant Proc 2001;33(1-2):185-8­9.  Back to cited text no. 2
    
3.Winkelhorst JT, Brokelman WJ, Tiggeler RG, Wobbes T. Incidence and clinical course of denovo malignancies in renal allograft reci­pients. Eur J Surg Oncol 2001;27(4):409-13.  Back to cited text no. 3
    
4.Nafar M, Einollahi B, Hemati K, Gholi FP, Firouzan A. Development of malignancy fol­lowing living donor kidney transplantation. Transplant Proc 2005;37(7):3065-7.  Back to cited text no. 4
    
5.Rascente M, Pisani F, Barletta A, et al. Malig­nancies after kidney transplantation. Transplant Proc 2005;37(6):2529-31.  Back to cited text no. 5
    
6.Birkeland SA, Lokkegaard H, Storm HH. Cancer risk in patients on dialysis and after renal transplantation. Lancet 2000;355(9218): 1886-7.  Back to cited text no. 6
    
7.Adami J, Gabel H, Lindelof B, et al. Cancer risk following organ transplantation: a nation­wide cohort study in Sweden. Br J Cancer 2003;89(7):1221-7.  Back to cited text no. 7
    
8.Harzallah K, Abderrahim E, Chareffedine K, et al. Cancers after renal transplantation: Multi­center experience. Saudi J Kidney Dis Transpl 2008;19:825-30.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Penn I. Malignancy in renal transplant reci­pients. Saudi J Kidney Dis Transpl 1996;7:1-5.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Altaee IK, Jaleel NA, Aljubury HM, Alshamaa IA, Gazala S. Incidence and types of malign­nancies in renal transplant recipients in Iraq. Saudi J Kidney Dis Transpl 2006;17(3):408-14.  Back to cited text no. 10
    
11.Marcen R, Pascual J, Tato AM, et al. Influence of immunosuppression on the prevalence of cancer after kidney transplantation. Transplant Proc 2003;35(5):1714-6.  Back to cited text no. 11
    
12.Tang Y, Zhang Y, Jia B. Analysis of 2200 kidney transplantations. Zhonghua Yi Xue Za Zhi 2001;81(2):82-5.  Back to cited text no. 12
    
13.Andres A. Cancer incidence after immunosup­pressive treatment following kidney transplan­tation. Crit Rev Oncol Hematol 2005;56(1):71-85.  Back to cited text no. 13
    
14.Moloney FJ, Comber H, O'Lorcain P, O'Kelly P, Conlon PJ, Murphy GM. A population­based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol 2006;154(3):498-504.  Back to cited text no. 14
    
15.Stefoni S, Scolari MP, Sestigiani E, et al. Renal transplantation and malignancies: A single­ centre experience (25 years). G Ital Nefrol 2002;19(6): 650-7.  Back to cited text no. 15
    
16.Harzallah K, Frimat L, Kessler M, et al. Solid and skin tumors after Kidney transplantation: Which risk factors? Am J Transplant 2006; 6(S2):65-1061.  Back to cited text no. 16
    

Top
Correspondence Address:
Reza Alizadeh-Navaei
Kidney Transplantation Center, Shahid Beheshti Hospital, Babol
Iran
Login to access the Email id


PMID: 21060171

Rights and Permissions



 
 
    Tables

  [Table 1]

This article has been cited by
1 Benefits associated with antiviral treatment in kidney allograft recipients with chronic hepatitis B virus infection
Cosconea, S. and Fontaine, H. and Méritet, J.-F. and Corouge, M. and Sogni, P. and Vallet-Pichard, A. and Mallet, V. and Legendre, C. and Pol, S.
Journal of Hepatology. 2012; 57(1): 55-60
[Pubmed]
2 Viral infection in renal transplant recipients
Cukuranovic, J. and Ugrenovic, S. and Jovanovic, I. and Visnjic, M. and Stefanovic, V.
The Scientific World Journal. 2012; 2012(820621)
[Pubmed]
3 Seroprevalence of Human herpesvirus 8 (HHV-8) and incidence of Kaposiæs sarcoma in Iran
Jalilvand, S. and Shoja, Z. and Mokhtari-Azad, T. and Nategh, R. and Gharehbaghian, A.
Infectious Agents and Cancer. 2011; 6(1)
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    Acknowledgment
    References
    Article Tables
 

 Article Access Statistics
    Viewed1933    
    Printed76    
    Emailed0    
    PDF Downloaded394    
    Comments [Add]    
    Cited by others 3    

Recommend this journal