Malignancies After Kidney Transplantation
Özet
The risk of malignancy after kidney transplantation is significantly higher than in the general population and is among the most critical complications affecting long-term survival and quality of life in transplant recipients. In the pretransplant period, disease-free waiting periods, determined by the cancer's biological behavior and stage, are fundamental to ensuring oncological safety. In the posttransplant period, cumulative immunosuppressive burden is the most important modifiable risk factor. T-cell-depleting induction therapies and calcineurin inhibitors (CNIs), in particular, increase the risk of cancer. Furthermore, Torque Teno Virus (TTV) burden is a notable functional biomarker that reflects the patient's immune competence and predicts the risk of malignancy that may develop due to excessive immunosuppression. Among de novo malignancies frequently seen in kidney transplant recipients, cutaneous squamous cell carcinoma tends to be more aggressive, multifocal, and to present at an earlier age than in the general population. Lymphoproliferative diseases, which are a significant risk in the early post-transplant phase, are among the most aggressive cancers linked to viral reactivation. In the urogenital system, native kidney renal cell carcinoma is notably prominent. The basic principles of malignancy management are based on establishing a delicate balance between oncological efficacy and the preservation of graft function, and on a multidisciplinary decision-making process. In this context, individualizing therapy and reducing the cumulative immunosuppressive burden, the most important modifiable risk factor, is the fundamental treatment strategy. The strategic switch from CNIs to mTOR inhibitors (sirolimus/everolimus) is critical, particularly for Kaposi's sarcoma and non-melanoma skin cancers, given their antitumor and antiangiogenic effects. Although immune checkpoint inhibitors used to treat advanced-stage cancers yield significant oncological responses, they carry a high risk of irreversible graft rejection. In conclusion, oncological risk management in kidney transplant recipients requires individualized immunosuppressive protocols, regular screening, and a multidisciplinary approach.
Referanslar
Brennan DC, Lentine KL. Kidney transplantation in adults: Evaluation of the potential kidney transplant recipient. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.; 2026. Accessed April 23, 2026.
Wong G, Lim WH. Prior cancer history and suitability for kidney transplantation. Clin Kidney J. 2023;16(11):1908–1916.
Al-Adra DP, Hammel L, Roberts J, et al. Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation: A consensus expert opinion statement. Am J Transplant. 2021;21(2):475–483.
Al-Adra DP, Hammel L, Roberts J, et al. Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement. Am J Transplant. 2021;21(2):460–474.
Al-Adra D, Al-Qaoud T, Fowler K, et al. De novo malignancies after kidney transplantation. Clin J Am Soc Nephrol. 2022;17(3):434–443.
Brennan DC, Rodeheffer RJ, Ambinder RF. Malignancy after solid organ transplantation. In: Vella J, Sawinski D, eds. UpToDate. Waltham, MA: UpToDate Inc.; 2026. Accessed April 25, 2026.
Hellemans R, Pengel LH, Choquet S, et al. Managing immunosuppressive therapy in potentially cured post-kidney transplant cancer: An overview of the available evidence and guidance for shared decision-making. Transpl Int. 2021;34(10):1789–1800.
Herz C, Haupenthal F, Doberer K, et al. Torque teno virus is associated with an increased risk for malignancies after kidney transplantation. Nephrol Dial Transplant. 2025;40(Suppl 3):gfaf116.
Herz CT, Haupenthal F, Herkner F, et al. Torque teno virus is predictive for malignancies after kidney transplantation. Nephrol Dial Transplant. 2026;gfag078.
Kulbat A, Richter K, Stefura T, et al. Systematic review of calcineurin inhibitors and incidence of skin malignancies after kidney transplantation in adult patients: A study of 309,551 cases. Curr Oncol. 2023;30(6):5727–5737.
Fuhrmann JD, Valkova K, von Moos S, et al. Cancer among kidney transplant recipients >20 years after transplantation: Post-transplant lymphoproliferative disorder remains the most common cancer type in the ultra long-term. Clin Kidney J. 2022;15(6):1152–1159.
Negrin RS, Brennan DC. Treatment and prevention of post-transplant lymphoproliferative disorders. In: Chao NJ, ed. UpToDate. Waltham, MA: UpToDate Inc.; 2025. Updated January 2, 2025. Accessed April 25, 2026.
Małyszko SJ, Rog L, Sprangers B, et al. Malignancy of urinary tract in kidney transplant recipients: A narrative review. Cancers (Basel). 2026;18(4):695.
Murakami N, Mulvaney P, Danesh M, et al. Safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant: A multicenter study. Kidney Int. 2021;100(1):196–205.
