title: Renal cancer in kidney transplanted patients.
abstract: Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
authors.affiliation: Nephrology, Dialysis and Renal Transplantation Unit, Ospedali Riuniti, V. Conca 71, 60020, Ancona, Italy. gm.frasca@ospedaliriuniti.marche.it.
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Frascà
authors.affiliation: U.O. Nefrologia, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Sandrini
authors.affiliation: Nephrology and Dialysis Unit, Istituti Ospitalieri Cremona, Cremona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cosmai
authors.affiliation: Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.affiliation: Section of Nephrology, Department of Medicine, Yale School of Medicine and the Yale New Haven Transplantation Center, New Haven, CT, USA.
authors.forename: William
authors.initials: W
authors.lastname: Asch
authors.affiliation: Clinica di Oncologia Medica-Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: U.O. Nefrologia, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Salviani
authors.affiliation: "F. Addarii" Institute of Oncology and Transplantation Pathology, Bologna University, Bologna, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: D'Errico
authors.affiliation: "F. Addarii" Institute of Oncology and Transplantation Pathology, Bologna University, Bologna, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Malvi
authors.affiliation: Nephrology, Dialysis and Renal Transplantation Unit, Ospedali Riuniti, V. Conca 71, 60020, Ancona, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Balestra
authors.affiliation: Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy.|Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
mesh_terms: D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D055088:Early Detection of Cancer; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D052177:Kidney Diseases, Cystic / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016891:Polycystic Kidney, Autosomal Dominant / Q000453:epidemiology; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases
keywords: Calcineurin inhibitors; Immunosuppressive therapy; Renal cancer; Renal transplantation; mTOR inhibitors