Cancer in Renal Transplant Patients

In the current era of immunosuppression, renal transplantation is considered the gold standard for renal replacement therapy. In addition to excellent 1-year (95%), and 5-year (80%) graft survival, the mortality advantage over those remaining on dialysis makes it the therapy of choice. This success is due to the use of better immunosuppressant regimens that have prevented graft loss; however, it has resulted in the increased risk of infection and malignancy. In fact, the three most common causes of death of patients with a functioning kidney graft are cardiovascular, infectious and malignancy related.The increased risk of malignancy is thought to be multi-factorial. The issues include: (1) increased risk of genitourinary and thyroid malignancies related to chronic kidney disease; (2) immunosuppression that suppresses the immune system's tumor surveillance, promotes the development of pro-oncogenic viruses and intrinsically causes the development of malignancies, and (3) the spread of donor-derived malignancies via grafts.In this chapter, the above concepts will be explored and the most practical approaches will be offered to help the clinician screen for malignancy and manage immunosuppression in a post-kidney transplant recipient who is always at an increased risk for malignancy.