Solid Organ Transplant Recipients May Face Higher Cancer Risk
Receiving an organ transplant surely is known to save a life; however, there are risks involved. One very important consideration is that transplant recipients, due to a weakened immune system, are at an elevated risk for certain kinds of cancers.
Researchers with the National Cancer Institute examined data from more than 175,000 organ transplants performed in the United States between 1987 and 2008 using information from the Scientific Registry of Transplant Recipients and 13 US population-based cancer registries. The majority of the cases had kidney transplants, followed by liver, heart, and lung. The mean age at the time of transplantation was 47, and 61% of cases were men.
Overall, there were 10,656 malignancies diagnosed in the overall cohort, indicating a twice-as-likely risk among transplant recipients for the development of cancer over the general population. The most common kind of cancer was non-Hodgkin’s lymphoma, a cancer of the lymphoid tissue which includes the lymph nodes, spleen and other organs of the immune system. Organ recipients are also at a greater risk of developing skin cancer, stomach cancer, oropharynx cancer and vulva or penile cancer.
Many cancers were also detected in the original damaged organ, notes senior investigator Dr. Eric Engels MD, so often, those who received an organ developed cancer in the same location (ie: lung transplant recipient develops lung cancer). Again, this is likely due to a weakened immune system. A risk of kidney cancer may be exacerbated by the use of nephrotoxic immunosuppressive therapies.
Patients who do receive organ transplants are urged to maintain the recommended follow-up care after their surgery, including receiving recommended screenings such as colonoscopies and PAP smears. They should also follow healthful habits such as sun protection and avoidance of cigarette smoke.
Although the risk of cancer is higher in transplant patients, this should not deter patients from seeking organs in the case of end-stage disease. "Yes, the risk of cancer is higher, but the alternative to transplant is usually death," said Dr. Jeffrey Punch, chief of transplantation in the department of surgery at University of Michigan. "In the case of kidney transplantation where the alternative is dialysis, it still doesn't make sense to dwell on the cancer risk because the most common cause of death in patients with kidney disease is ... heart attacks and strokes."
Engels E, et al "Spectrum of cancer risk among US solid organ transplant recipients" JAMA 2011; 306: 1891-1901.