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• W2334758477 abstract "The consequences of cancer in transplantation have been a fashionable discussion topic in specialist journals over the last couple of years. Rightly so. With improving patient survival after solid organ transplantation, mortality because of malignant tumors is increasingly important, affecting up to 20% of graft recipients after 10 years. A number of articles on the subject of donor cancer transmission (1, 2) have led to the resetting of our standard point; because some of these publications have balanced the risk between cancer transmission and remaining on the waiting list, guidelines to clinicians have taken a different emphasis (3). Advice concerning recurrence of malignancy is based on large data sources, such as the excellent Israel Penn Registry http://ipittr.uc.edu/. Yet, it is sad to note that most experienced clinicians have memory of patients suffering aggressive tumor recurrence after transplantation when they had been deemed “cured” by their oncologist at transplant assessment. In this journal, Ma et al. (4) advance a new thesis, different to the conventional theory which states that increased cancer risk after transplantation is linked to heavier immunosuppression, viral infection/transmission or a combination of these. It is interesting to note that the registry data from which this new article is drawn has also been used to add evidence in support of this conventional theory in the past (5, 6). The new article analyzes cancer risk in relation to different types of kidney donation (live donor, standard deceased donor, or extended criteria donor) concluding that each type, independent of any other relevant factor, affects cancer risk in the recipient. The authors have attempted to control for immunosuppression and find the donor type to be an independent predictive factor for cancer risk. The argument goes that each type of donor organ excites a different immune response, and this is linked to the ability of that immune system to deal with perturbed cells. There remains a concern that, despite valiant effort, the authors have not been able to measure the total immunosuppression load given to each of the three groups of patients in the limited data available to them (use of induction therapy, yes or no, and initial level of immunosuppression only). The result is that the findings from this article require to be checked in other registries (or large center studies), especially where more detail of immunosuppression is recorded. In transplantation, any particular donor and recipient pairing is always a balance between the risk of mortality while remaining on the waiting list versus the risk of transplantation. Indeed, the authors of this paper have also written about the increased cancer risk in dialysis patients (7). All these recent papers on the subject of cancer and transplantation have given more information in this important area and perhaps have allowed us to be a little less risk averse in carrying on with transplantation when considering the risks of remaining on the waiting list. Even more importantly, the articles allow us to inform our patients better." @default.
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• W2334758477 date "2014-12-27" @default.
• W2334758477 modified "2023-09-25" @default.
• W2334758477 title "Tumors and Transplant" @default.
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• W2334758477 doi "https://doi.org/10.1097/tp.0000000000000380" @default.
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