Post-transplant malignancy amongst kidney transplant recipients: a single centre 20-year experience and literature review
George Kurian1, Sandeep Sreedharan1, Rajesh R Nair1, Zachariah Paul1, Shabeen Kumar1, Anil Mathew1.
1Nephrology, Amrita institute of medical sciences and research, Ernakulam, India
Materials and Methods: We analysed our data retrospectively which included 794 patients who underwent renal transplantation at our centre between January 2001 to February 2022. Patient’s native kidney disease, donor details, duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. All details regarding the nature of the malignancy with detailed histopathology, staging, and treatment were also collected. We also done subgroup analysis of multiorgan, liver and hand transplant recipients.
Results: Of the total 794 cases of renal transplant recipients, 15 recipient (1.7%) were diagnosed with malignancy. Seven out of the 15 patients were males (46%). The mean age at diagnosis was 41±10 years and mean duration of occurance of malignancy following post transplant was 38 months. Eight patients(46%) developed solid organ tumour and 7 (54%) developed post-transplant lymphoproliferative disease. Of the eight cases of solid organ tumors, 4 had squamous cell carcinoma of the tongue followed by one case each of adenocarcinoma of the pancreas, adenocarcinoma of colon and squamous cell carcinoma of the lung and vulva. Seven out of 15 patients succumbed to their malignancy, a mortality rate of 46%. Of the seven cases of PTLD, 6 had expired(86%), making PTLD the most fatal post-transplant malignancy in our setting. Of the 794 post-kidney transplant cases reviewed in this single center retrospective study, the incidence of malignancy was 1.8 per 100 population. At our centre, there was a prevalence of PTLD as the major type of post-transplant malignancy, as compared to studies from other centers. PTLD being of poor prognosis, is responsible for a higher post-transplant mortality rate of 54% in our population. The most aggressive histopathological variant of PTLD(Monomorphous variant) was common in our cohort. This may represent either an ethnic predisposition to this disease or some environmental or immunological risk factors contributing to it occurrence.
Conclusion: This study points out the need for meticulous surveillance of all post-transplant cases for malignancy considering the associated high rate of mortality.
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