Managing comorbidities

Although very rare, cancer can be transmitted through deceased and living donor organ, cell and tissue transplantation. Treatment of donor-related tumors consists of changing, reducing or stopping immunosuppressive drug therapy, returning to chronic hemodialysis (for renal recipients) and possible re-transplantation.

Transplant recipients with a history of pre-existing malignancies have a very low incidence of recurrence post-transplant. Recurrence rates are affected by the specific type of cancer, the extent of the disease at treatment, the time elapsed since the treatment and how that type of cancer normally progresses.

Transplant recipients have an increased risk of developing new cancers in general (one to two percent per year) and a 15-20 percent higher incidence of certain types of cancer. Skin cancer and lymphomas (cancers of the lymph glands) are the most prevalent types of cancer seen post-transplantation. The risk of cervical, breast cancer, and colorectal cancer are also increased. Post-transplant patients, have a significantly increased risk of developing squamous cell carcinomas, as well as increased risk for other types of skin cancers, such as melanoma. A smaller number of transplant recipients develop lymphoma within a year of the operation. This cancer is the growth of white blood cells in the body’s immune system. There are several treatment options that require careful assessment by your specialists. Some lymphomas go away if anti-rejection drugs are reduced or stopped, while some will respond to drugs (chemotherapy) or X-ray treatment (radiotherapy). A small number of patients develop non-skin, non-lymphoma cancers. When this occurs, standard cancer treatment options, including surgery, radiotherapy and chemotherapy must be individualized to the patient, and coordinated by the oncologist and transplant surgeon/physician.