Role of cytomegalovirus and Epstein-Barr virus in patients with de novo colon cancer after renal transplantation.
OBJECTIVE
The development of new effective immunosuppressive agents has provided long-term survival for transplant recipients, thereby increasing the risk of de novo malignancy in chronic immunocompromised hosts. Although de novo post-transplant lymphoproliferative diseases and skin cancer have been shown to have an increased incidence in long-term surviving solid organ transplant recipients, the association with colon cancer is controversial.


METHODS
Over a 12-year period, 20 patients (5%) out of 400 renal transplant recipients (treated at the University Hospitals of Udine and Ancona) developed 24 de novo tumors; 11 skin cancers and 13 non-skin cancers. Three patients developed de novo colon cancer. Immunosuppressive therapy was reduced immediately after diagnosis, and all patients were shifted from cyclosporine to rapamycin within 30 days. The tumor was surgically resected with curative intent in 2 cases, and 1 patient had only palliative surgery due to metastatic disease. The postoperative course was uneventful, and all patients maintained normal graft function.


RESULTS
Two of 3 patients died of progression of the neoplasm, within a median time from the diagnosis of 12 months. We analyzed the possible correlations between de novo colon cancer and "serology (hepatitis C virus-hepatitis B virus, HCV-HBV) status" infections, cytomegalovirus and Epstein-Barr virus reactivation, episodes of rejection, and blood transfusions.


CONCLUSIONS
Differently from other de novo skin and non-skin tumors, our cases developed cytomegalovirus and Epstein-Barr virus reactivation within 3 months of transplantation. Therefore, we suggest a closer follow-up for de novo colon cancer in renal transplants with early cytomegalovirus and Epstein-Barr virus reactivation in order to avoid a delay in diagnosis.
Adani
Gian Luigi
GL
Department of Surgery and Transplantation Unit, University Hospital of Udine, Udine, Italy. adanigl@hotmail.com
Baccarani
Umberto
U
Lorenzin
Dario
D
Bresadola
Vittorio
V
Currò
Giuseppe
G
Sainz
Mauricio
M
Gropuzzo
Maria
M
Montanaro
Domenico
D
Tulissi
Patrizia
P
Risaliti
Andrea
A
Bresadola
Fabrizio
F
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002102:Cadaver; D015179:Colorectal Neoplasms / Q000601:surgery / Q000821:virology*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D003587:Cytomegalovirus / Q000302:isolation & purification / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000150:complications*; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus