De Novo Solid Tumors After Kidney Transplantation: Is It Time for a Patient-Tailored Risk Assessment? Experience From a Single Center

Our plain-English summary of De Novo Solid Tumors After Kidney Transplantation: Is It Time for a Patient-Tailored Risk Assessment? Experience From a Single Center, by A. Rossetto, P. Tulissi, F. De Marchi, et al (Transplantation Proceedings, 2015).

The study

• Authors: A. Rossetto, P. Tulissi, F. De Marchi, M. Gropuzzo, C. Vallone, G.L. Adani, U. Baccarani, D. Lorenzin, D. Montanaro, A. Risaliti
• Journal: Transplantation Proceedings
• Published: 2015;47(7):2116-20
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Progress in immunosuppressive therapy and perioperative techniques has improved the survivals of both grafts and patients. The patient, however, is exposed to the risks of aging and side effects of immunosuppression. De novo tumors are the 2nd cause of death in the organ transplant population. The aim of this study was to evaluate whether the current accepted guidelines for the pre-transplantation study and the post-transplantation follow-up have been effective, in our kidney transplant population, regarding early detection and treatment, improving prognosis, and reducing mortality of some curable neoplastic diseases.

Methods: We considered de novo tumors in kidney transplant patients from 1995 to 2010 (n = 636) excluding hematologic and nonmelanoma skin tumors from our study.

Results: There were 64 de novo tumors in 59 patients out of 636 kidney transplant patients; 29.68% were urogenital cancer, 26.56% gastrointestinal cancer, 12.5% melanoma, 6.25% lung cancer, 6.25% biliopancreatic cancer, 4.68% visceral Kaposi sarcoma, 4.68% breast cancer, 4.68% thyroid cancer, 1 pleural mesothelioma, 1 meningioma, 1 merkeloma. Twenty patients died because of cancer. Ten patients had a late de novo tumor diagnosis, when the stage of tumor was advanced and not suitable for curative treatment.

Conclusions: Because of the increased neoplastic risk, we consider it mandatory to carry out a meticulous screening and to implement pre-transplantation study concerning this increased neoplastic risk population to detect a subgroup of patients presenting the highest risk to improve their outcome.

Copyright © 2015 Elsevier Inc. All rights reserved.

In plain English

This was a retrospective review of kidney transplant patients at a single center in Udine, Italy, from 1995 to 2010. The authors looked at new (de novo) solid tumors that appeared after transplantation, excluding blood cancers and skin cancers other than melanoma. Of 636 transplant patients, 59 developed 64 tumors. The most common were urogenital cancers (19, or 29.68%) and gastrointestinal cancers (17, or 26.56%), followed by 8 melanomas and 4 lung cancers. There was 1 pleural mesothelioma. Patients who developed tumors were older at transplantation (56 vs 50 years). They more often had glomerulonephritis, and less often diabetes, as the cause of kidney failure. Of the 59 patients with tumors, 25 died, 20 of them from cancer. The mesothelioma patient died soon after diagnosis because the disease was too advanced. One patient with lung adenocarcinoma had environmental exposure to asbestos and tobacco and died with an advanced tumor. The authors concluded that combining patients' risk factors might identify a very high cancer-risk group who should receive closer, customized checks before and after transplantation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center review of kidney transplant recipients, comparing those who developed de novo solid tumors with those who did not
• Who was studied: 636 kidney transplant patients at the Udine center, Italy, 1995 to 2010. 59 of them developed de novo solid tumors (hematologic tumors and nonmelanoma skin tumors excluded) and 577 did not
• Exposure: Kidney transplantation with immunosuppressive therapy. The study did not examine asbestos as an exposure; asbestos is mentioned only for one patient with lung adenocarcinoma, who had environmental exposure to asbestos and tobacco
• Main results:
  • Among the 64 tumors there were 19 urogenital cancers (29.68%), 17 gastrointestinal cancers (26.56%), 8 melanomas (12.5%) and 4 lung cancers (6.25%)
  • The 64 tumors also included 1 pleural mesothelioma, 1 meningioma and 1 merkeloma
  • The mesothelioma, diagnosed 36 to 60 months after transplantation, was too advanced at diagnosis, and the patient died soon after
  • The lung adenocarcinoma patient with environmental asbestos and tobacco exposure was diagnosed in the 3rd year after transplantation and died with a tumor too advanced for staging
  • Age at transplantation was 56 years in patients who developed tumors versus 50 years in those who did not (P = .004). The difference in the share of men (78% vs 67%) was not statistically significant
  • Glomerulonephritis as the cause of kidney failure was more common in patients who developed tumors (40% vs 11%, P less than .001). Diabetes was less common in that group (3.5% vs 23%, P less than .001)
  • Among the 59 patients with tumors, 25 (42%) died, 20 of them from cancer. Ten had a late diagnosis at an advanced stage not suitable for curative treatment
  • Mortality in this population was 22% for urogenital tumors and 41% for gastrointestinal tumors
• The authors' conclusion: The authors concluded that matching pre-transplantation, environmental and behavioral risk factors (including environmental exposure, tobacco and alcohol) with the usual post-transplantation evaluations might define a very high cancer-risk population. In their view these patients should receive customized pre- and post-transplantation studies
• Limitations the authors state:
  • The follow-up period was not long enough for all patients to allow very-long-term conclusions
  • Other variables, such as rejection episodes and viral reactivations, were not considered
  • Possible differences between immunosuppressive regimens were not analyzed

Topics

Medical terms in this study, explained in our Lexicon: De Novo, Prognosis, Lung Cancer, Sarcoma, Pleural Mesothelioma.

Related studies

• Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009 — P. Piselli, D. Serraino, et al. (2013)
• Malignant pleural mesothelioma in a kidney transplant recipient — W. Traipipitsiriwat, C. Songsomboon, et al. (2021)
• Phase I trial of tirapazamine in combination with cisplatin in a single dose every 3 weeks in patients with solid tumors — C.A. Johnson, D. Kilpatrick, et al. (1997)
• Pembrolizumab in paediatric patients with advanced melanoma or a PD-L1-positive, advanced, relapsed, or refractory solid tumour or lymphoma (KEYNOTE-051): interim analysis of an open-label, single-arm, phase 1-2 trial — B. Geoerger, H.J. Kang, et al. (2020)
• Time-related factors in quantitative risk assessment — K.S. Crump, B.C. Allen, et al. (1987)
• Immunohistochemistry in Peritoneal Mesothelioma: A Single-Center Experience of 244 Cases — R.T. Tandon, Y. Jimenez-Cortez, et al. (2018)

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