Malignancy after transplantation.
As newer immunosuppressive regimens have steadily reduced the incidence of acute rejection and have extended the life expectancy of allograft recipients, posttransplant malignancy has become an important cause of mortality. In fact, it is expected that cancer will surpass cardiovascular complications as the leading cause of death in transplant patients within the next 2 decades. An understanding of the underlying pathobiology and how to minimize cancer risks in transplant recipients are essential. The etiology of posttransplant malignancy is believed to be multifactorial and likely involves impaired immunosurveillance of neoplastic cells as well as depressed antiviral immune activity with a number of common posttransplant malignancies being viral-related. Although calcineurin inhibitors and azathioprine have been linked with posttransplant malignancies, newer agents such as mycophenolate mofetil and sirolimus have not and indeed may have antitumor properties. Long-term data are needed to determine if the use of these agents will ultimately lower the mortality due to malignancy for transplant recipients.
Buell
Joseph F
JF
Israel Penn International Transplant Tumor Registry, University of Cincinnati, Cincinnati, OH 45267-0558, USA. joseph.buell@uc.edu
Gross
Thomas G
TG
Woodle
E Steve
ES
D001379:Azathioprine / Q000009:adverse effects; D065095:Calcineurin Inhibitors; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D016572:Cyclosporine / Q000009:adverse effects; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000628:therapy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D020123:Sirolimus / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000139:chemically induced; D016559:Tacrolimus / Q000009:adverse effects; D014181:Transplantation Immunology; D014184:Transplantation, Homologous / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D020123:Sirolimus; D016559:Tacrolimus