Many patients with end-stage organ failure can only live a little longer with an organ transplant. Since its inception, this procedure has been associated with a number of risks. After an organ transplant, cancer is one of the three leading causes of death. The other two causes of death following an organ transplant are infection and cardiovascular disease; however, effective screening, prophylaxis, and interventional therapies are reducing their incidence. In terms of early detection and established guidelines, an understanding of post-transplant cancer is inadequate. Due to variations in clinical presentation, altered immune dynamics, and host response, the risk factor is most difficult to identify. After an organ transplant, there is an overall two to fourfold increased risk of cancer, according to studies.
Long-term immunosuppression, which reduces immune surveillance of neoplastic cells, and opportunistic post-transplant infections, particularly viral infections caused by Epstein-Barr virus (EBV), varicella, cytomegalovirus (CMV), and human herpesvirus (HHV)-8, among others, are the mechanisms involved in oncogenesis. The fact that cancer following an organ transplant is more biologically aggressive and that patients may receive less aggressive cancer treatment due to comorbidities and the fear of transplant rejection presents a challenging challenge for both physicians and patients.
Risk of cancer progression following an organ transplant
The largest and most comprehensive registry in the world, the Israel Penn International Transplant Tumor Registry (IPITTR), identifies non-melanoma skin cancers (NMSCs) as the most common type of cancer in states where organ transplants have taken place. The following is a list of various cancers that have been linked to the transplant of an organ:
- Kaposi sarcoma • Skin (nonmelanoma, nonepithelial) • Non-Hodgkin lymphoma • Liver • Anus • Vulva • Lip • Lung • Kidney • Colon and rectum • Pancreas • Hodgkin’s lymphoma • Melanoma • The patient, the transplant, and medication-related factors are the risk factors for post-transplant malignancy.
Risk factors
Patient-Related Risk Factors
The patient’s advanced age is a well-described risk factor that has been shown to increase the likelihood of developing skin cancer. Sun exposure and a transplant recipient’s history of cancer are also strong risk factors. Smoking and drinking are both associated with a high mortality risk and are risk factors for carcinogenesis.
Relating to Transplants
There is a correlation between the risk of developing cancer and the kind of transplant—living or deceased. The risk of PTLD and genitourinary cancer is lower in patients who receive kidneys from living donors. Donor transmission as a cause of post-transplant malignancy is uncommon, but it has been documented as a method of carcinogenesis; melanoma, malignant growth of lung, bosom, colon, rectum, kidney, Kaposi sarcoma, and glioblastoma multiforme all have been accounted for to be communicable from givers.
Caused by Medication
Immunosuppressive medications make it harder for immune cells to detect malignant cells and make it more common for viruses to cause cancer. The rate of carcinogenesis is influenced by immunosuppressive therapy’s type, intensity, and duration.
Management
Immunosuppression reduction in treatment: Patients who received a renal transplant benefit most from reducing or stopping immunosuppressive treatment because rejection of the graft is not fatal in these patients. Sometimes, these measures can result in the regression of tumors like PTLD, some skin cancers, and Kaposi sarcoma (KS). It’s possible that decreased exposure to calcineurin inhibitors is important.
Cancers of the Anogenital area: Laser therapy, electrocautery, and topical fluorouracil can be used to treat in situ anogenital cancers. Wide local excision (such as APR) and inguinal lymphadenectomy are required for invasive tumors.
Malignancy in the visceral organs: Standard surgical, radiotherapeutic, or chemotherapeutic methods will be used to treat visceral cancers.
Post-transplant lymphoproliferative disorder (PTLD): The treatment for PTLD has undergone significant change over time, which merits special mention. Reducing immunosuppression, immunotherapy with the CD20 monoclonal antibody (rituximab), chemotherapy, radiation therapy, or a combination of these are the primary options for initial treatment.
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