Malignancies After Kidney Transplantation
The
risk of malignancy after kidney transplantation is significantly higher than in
the general population and is among the most critical complications affecting
long-term survival and quality of life in transplant recipients. In the
pretransplant period, disease-free waiting periods, determined by the cancer's
biological behavior and stage, are fundamental to ensuring oncological safety.
In the posttransplant period, cumulative immunosuppressive burden is the most
important modifiable risk factor. T-cell-depleting induction therapies and
calcineurin inhibitors (CNIs), in particular, increase the risk of cancer.
Furthermore, Torque Teno Virus (TTV) burden is a notable functional biomarker
that reflects the patient's immune competence and predicts the risk of
malignancy that may develop due to excessive immunosuppression. Among de novo
malignancies frequently seen in kidney transplant recipients, cutaneous
squamous cell carcinoma tends to be more aggressive, multifocal, and to present
at an earlier age than in the general population. Lymphoproliferative diseases,
which are a significant risk in the early post-transplant phase, are among the
most aggressive cancers linked to viral reactivation. In the urogenital system,
native kidney renal cell carcinoma is notably prominent. The basic principles
of malignancy management are based on establishing a delicate balance between
oncological efficacy and the preservation of graft function, and on a
multidisciplinary decision-making process. In this context, individualizing
therapy and reducing the cumulative immunosuppressive burden, the most
important modifiable risk factor, is the fundamental treatment strategy. The
strategic switch from CNIs to mTOR inhibitors (sirolimus/everolimus) is
critical, particularly for Kaposi's sarcoma and non-melanoma skin cancers,
given their antitumor and antiangiogenic effects. Although immune checkpoint
inhibitors used to treat advanced-stage cancers yield significant oncological
responses, they carry a high risk of irreversible graft rejection. In
conclusion, oncological risk management in kidney transplant recipients
requires individualized immunosuppressive protocols, regular screening, and a
multidisciplinary approach.
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