Malignancy in Egyptian living-donor kidney transplant recipients

Abstract

Background/Aims: A markedly increased incidence of malignancy among transplant recipients is well recognized. However, the incidence and pattern of post-transplantation malignancies show some discrepancy in different reports. The aim of this work was to study malignant complications in our kidney transplant patients.

Patients & methods: Out of 1200 live donor kidney transplantations performed in our center, 50 patients experienced 52 clinically evident malignancies (4.3%).

Results: The recipient mean age at the time of cancer diagnosis was 36.6 ± 8.6 years, and 36 were males. They developed malignancy at a mean interval of 112 ± 53 months post transplantation, and the range of follow up after diagnosis was 67-207 months. Forty patients (80%) received cyclosporine (CsA) as one of the immunosuppressive drugs. The main de novo malignancies were 24 Kaposi's sarcomas, 5 lymphomas, 5 breast cancers, 4 bladder cancers. The patients with malignancy had a significantly higher incidence of both acute rejection episodes during the first year after transplantation and the cumulative dose of steroids after 12 month. Tailored reduction of immunosuppressive drugs was initially tried in all patients. However, some patients still needed further specific treatment. Response to treatment was more favorable in Kaposi's sarcoma. Twenty six patients died, out of them 13 had functioning grafts.

Conclusion: We conclude that Kaposi’s sarcoma is the most prevalent post transplant malignancy in our locality and it carries the most favorable prognosis. Early diagnosis, modification of immunosuppression may help to control post-transplantation malignancy. Post- transplant malignancy may affect the graft and patient survival.