Organ transplantation and cancer
Organ transplantation is a medical procedure that involves transferring organs from a donor to a recipient, often to replace damaged or failing organs. While transplantation can save lives, it also presents certain health risks, particularly concerning cancer. Patients who undergo organ transplantation are typically required to take long-term immunosuppressive medications to prevent their bodies from rejecting the new organ. This suppression of the immune system not only increases the risk of infections but also elevates the likelihood of developing various types of cancer.
Transplant recipients face a significantly higher incidence of cancers, with some studies indicating that their risk can be two to four times greater than that of the general population. Common cancers among these patients include non-melanoma skin cancer, lymphoma, lung cancer, liver cancer, and kidney cancer. The development of cancer is often linked to the presence of malignant cells in the transplanted organ and the immunosuppressive therapy that follows. Routine screenings and close monitoring are essential for early detection and management of cancer in transplant recipients. Additionally, careful donor screening and adjustments in immunosuppressive regimens may help mitigate these risks, contributing to better outcomes for patients.
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Organ transplantation and cancer
RELATED CONDITIONS: Immune suppression, Kaposi sarcoma, nonmelanoma skin cancer, lymphoma
DEFINITION: When organs are transplanted, there is a potential to mechanically transmit diseases from the donor to the patient. Infections, malignant conditions, and autoimmune diseases are examples of easily transmittable conditions. Patients who receive transplanted organs must use long-term immunosuppressive therapy, drugs used to prevent organ rejection by suppressing the immune function of the body. If the immune system is weakened, the chance of developing cancer increases. Cancer risk is high for patients on dialysis for end-stage renal disease, often a precursor to kidney transplant.
Risk factors: Those having undergone organ transplantation are at risk for developing cancers.
Etiology and the disease process: An organ such as a liver, lung, or kidney can contain malignant cells or a tumor at the time of transplantation into a patient. Coupled with immunosuppressive therapy, which weakens the immune system, a cancer transplanted with an organ is generally aggressive and difficult to manage. As organs are more difficult to locate for transplant, older donors and donors with health issues may be used, increasing the risk of cancer transmission from a transplanted organ to the patient.
Although the immune system is most effective at fighting infection, it protects against cancer to a lesser degree by recognizing abnormal cells and attempting to control them. When the immune system is suppressed by drugs to prevent organ rejection, the body loses its ability to fight infection and abnormal cells. Cancers with a viral etiology are most encouraged by immunosuppressive therapy. Kaposi sarcoma, tumors just under the skin, may be transmitted by organ donation from donors infected with human herpesvirus 8 (HHV-8) but also may develop in patients with a preexisting infection when the immune system cannot help the body fight the infection. Lymphoma is most likely to occur in the first year after transplant or when treatment for organ rejection is started. The most common cancer in transplant patients is skin cancer. Non-Hodgkin lymphoma, lung cancer, liver cancer, and kidney cancer are also common. Cancer usually occurs in the first few years following a transplant.
Incidence: The risk of cancer after transplant can be two to four times higher than it is in the general population, and there is a much higher incidence of particular cancers. Patients on immunosuppressive therapy have a much greater risk of developing cancer than the normal population. Further, the cumulative probability for cancer after transplant increase over time. Nonmelanoma skin cancers account for 95 percent of skin cancers in transplant patients, and skin cancer in the transplant group has a rate 100 times higher than that of the normal population. According to the National Institutes of Health, non-Hodgkin lymphoma occurred in 14 percent of transplant recipients, lung cancer in 13 percent, liver cancer in 9 percent, and kidney cancer in 7 percent. Breast, colorectal, and cervical cancer risks are also increased after transplant.
Symptoms: Symptoms depend on the type of cancer that develops after transplantation. Skin cancers may be visible on the surface of the skin.
Screening and diagnosis: Transplant patients need to receive routine screenings for cancer according to recommended cancer screening guidelines and have routine physician visits as part of follow-up care. Patients should inspect their skin monthly for any changes indicating skin cancer. An annual examination by a dermatologist is recommended. There is a discussion that better screening of donors before organ donation should be a priority to prevent cancer transmission from affected organs. When symptoms present, diagnosis may include tests, laboratory tests, and physical examination. Staging depends on the cancer diagnosed and the status of the tumor, lymph nodes, and the presence or absence of metastasis at diagnosis.
Treatment and therapy: Careful dosing of immunosuppressive therapy to prevent organ rejection without totally depressing the immune system is critical. Some cancers may respond to changing the drugs and doses used in immunosuppressive therapy. If cancer is diagnosed, the treatments depend on the disease but generally include chemotherapy, radiation, and surgery.
Prognosis, prevention, and outcomes: The prognosis for patients developing cancer after transplant varies by the type of cancer. Because of the high risk of skin cancer, patients should avoid sun exposure. Screening patients and donors carefully before transplant may prevent some cancers. Lower doses of immunosuppressive therapy may contribute to preventing cancer. Newer types of immunosuppressive drugs, including one that reverses the presence of skin cancers, may decrease the incidence of cancer.
Bibliography
Chapman, Jeremy R., Angela C. Webster, and Germaine Wong. "Cancer in the Transplant Recipient." Cold Spring Harbor Perspectives in Medicine, vol. 3.7, 2013, pp. 1–15.
Desai, R., et al. "Estimated Risk of Cancer Transmission from Organ Donor to Graft Recipient in a National Transplantation Registry." British Journal of Surgery, vol. 101.7, 2014, pp. 768–74.
Engels, E. A. "Cancer in Solid Organ Transplant Recipients: There Is Still Much to Learn and Do." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 17, no. 8, 2017, p. 1967, doi.org/10.1111/ajt.14140. Accessed 3 July 2024.
Hall, Erin C., et al. "Cumulative Incidence of Cancer after Solid Organ Transplantation." Cancer, vol. 119.12, 2013, pp. 2300–308.
Hao, Xiaowei, et al. "Skin Cancer Outcomes and Risk Factors in Renal Transplant Recipients: Analysis of Organ Procurement and Transplantation Network Data from 2000 to 2021." Frontiers in Oncology, vol. 12, 2022, doi.org/10.3389/fonc.2022.1017498. Accessed 3 July 2024.
Kauffman, H. M., et al. “Deceased Donors with a Past History of Malignancy: An Organ Procurement and Transplantation Network/United Network for Organ Sharing Update.” Transplantation, vol. 84.2, 2007, pp. 272–74.
Niederwieser, D., et al. “Transmission of Donor Illness by Stem Cell Transplantation: Should Screening Be Different in Older Donors?” Bone Marrow Transplant, vol. 34.8, 2004, pp. 657–65.
“Organ Transplant and Skin Cancer Risk.” UCSF Health, www.ucsfhealth.org/education/organ-transplant-and-skin-cancer-risk. Accessed 3 July 2024.
Park, Boyoung, et al. "De Novo Cancer Incidence After Kidney and Liver Transplantation: Results from a Nationwide Population Based Data." Scientific Reports, vol. 9, no. 1, 2019, pp. 1-9, doi.org/10.1038/s41598-019-53163-9. Accessed 3 July 2024.
Robbins, Hilary A., and Jamie Kleiman. “After a Transplant: New Dangers.” The Skin Cancer Foundation, 20 Oct. 2023, www.skincancer.org/blog/after-a-transplant-new-dangers. Accessed 3 July 2024.
Serraino, D., et al. “Risk of Cancer Following Immunosuppression in Organ Transplant Recipients and in HIV-Positive Individuals in Southern Europe.” European Journal of Cancer, vol. 43.14, 2007, pp. 2117–23.