Cancer After Renal Transplantation F. Anaya, J. Plaza, D. Sanz-Guajardo, A. Luque, M. Rengel, J. Ferna ´ ndez, and M. Moreno T HE INCIDENCE of cancer after renal transplantation is remarkably higher than that in the general popula- tion, 1–4 amounting to between 3% and 9%, with a 6% mean. 5 Since 1968, when Dr Israel Penn founded the Cincinnati Transplant Tumor Registry (CTTR) now man- aged by Dr M. Roy First, the results of this registry have been collected and reported at regular 3 to 5 years inter- vals. 6 From these results it can be deduced that the types of neoplasia frequently observed in the general population (lung, breast, prostate, colon, and uterine cervix) have not increased but rather they have decreased, in frequency. However, the incidence of other types of tumors uncom- mon in the general population is highly significant in transplanted patients: lymphoma 25% vs 5%; lip cancer 7% vs 0.3%; Kaposi’s sarcoma 6% vs a virtually negligible incidence; renal carcinoma 5% vs 2%; vulva and perineum carcinoma 4% vs 1.5%; hepatic and biliary tumors 2.6% vs 1.4% and sarcomas (including Kaposi) 1.7% vs 0.5%. 7–9 The risk of occurrence of a tumor after renal transplan- tation depends on the tumor type and the time elapsed since transplantation. For Kaposi’s sarcoma it is about 22 months (1 to 225.5 months); 32 months for lymphomas (1 to 254 months); 69 months for epitheliomas (1 to 298.5 months); with vulva and perineal carcinoma having a much longer mean time of about 113 months (1 to 255 months). The probability of developing a malignant neoplasia in a renal transplant recipient monitored for 17 years is about 14% for noncutaneous cancers, 47% for skin carcinomas, and 55% for any other cancer type. 10 The majority are diagnosed at 4 to 5 years after transplantation. 11 We report the 32-year incidence and description of malignant tumors after renal transplantation. We examined 2121 transplants, 2006 corresponding to cadaveric donors and 115 to living donors, performed from 1970 to 2002 by the Asociacio ´n Madrid Trasplante (Madrid transplantation association). (Hospital Puerta de Hierro, Fundacio ´n Jime ´- nez Diaz and Hospital Universitario Gregorio Maran ˜on.) RESULTS Among the 2121 renal transplant patients, 90 tumors were found in 84 subjects, yielding an incidence of 4.24% for the transplant population. In six patients there were two neo- plasms. The 84 patients included 68 men and 16 women, with a mean age of 53  10 and 49  15 years, respectively. Eighty patients had received hemodialysis and four contin- uous ambulatory peritoneal dialysis (CAPD) during a mean transplantation waiting time of 4.3 years. It was the first transplantation for 74 patients and the second for 10 patients. The etiology of renal insufficiency was chronic glomeru- lonephritis in 43 patients, representing 51.1% vs 37.02% of the general transplanted population (P  .01); adult poly- cystic disease in 10 patients, 11.9% vs 10.49%; diabetes mellitus in nine patients, 10.7% vs 7.58%; interstitial ne- phritis in six patients, 8.3% vs 21.86% (P  .01); vasculitis in four patients, 4.76% vs 5.24%, and not specified in 11 patients, 14% vs 9.03%. The immunosuppressive agents used in these patients were prednisone in 100%; azathioprine in 82%; cyclospor- ine in 51%; mycophenolate in 17%; and tacrolimus in 8.7%. To date, no patient receiving rapamycin has developed a neoplasm. The 29 skin or lip related tumors (11 basal cell carcino- mas and 18 spinocellular) represent 33.3%. This frequency was followed by non-Hodgkin’s lymphomas or lymphopro- liferative diseases, namely 11 tumors (12.2%); lung cancer, 8.8%; and Kaposi’s sarcoma, 5.5% of cases. Renal cancer displayed the same incidence, while colon and rectum cancer had a 4.4% incidence. Breast, cervix, vulva, peri- neum, testicles, prostate, and hepatocarcinoma cancer are all below 3.5%. Fifty-eight tumors (64%) were treated surgically; 17 with radiotherapy (18.8%); 15 with chemo- therapy (16.6%); and 10 patients received palliative treat- ment (11.2%). No patient with skin and lip cancer displayed metastases. Of 12 tumors (13.3%) having metastases, the most frequent were adenocarcinomas. DISCUSSION Cancers occurring in transplanted patients are generally de novo. Pre-existing cancers may also relapse after transplan- tation but less frequently, as well as tumors being acciden- tally transmitted with the transplanted organ. The latter two types of cancer are characterized by an early appearance, given that they are usually diagnosed during the first year and show a high degree of malignancy. De novo neoplasms From the Asociacio ´ n Madrid-Trasplante, Nephrology Service, Hospital Gregorio Maran ˜o ´ n, Madrid, Spain. Address reprint requests to Dr F. Anaya, Nephrology Service, Hospital Gregorio Maran ˜o ´ n, Madrid, Spain. © 2003 by Elsevier Science Inc. 0041-1345/03/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/S0041-1345(03)00051-4 Transplantation Proceedings, 35, 697– 699 (2003) 697