Malignancy after Kidney Transplant James E. Cooper, M.D. Assistant Professor, Division of Renal Disease and Hypertension/Kidney and Pancreas Transplant Center University of Colorado and Health Sciences Center

Outline • Overview of malignancy rates and risk factors after kidney transplantation • Post-transplant malignancy in mTOR-I treated patients • Treatment of post-transplant malignancy and the potential role for mTOR-Is

Kidney transplant recipients are at higher risk for malignancy • Kasiske et al. performed a retrospective database analysis of 35,765 kidney recipients from 1995-2001 – Overall 3 year incidence of cancer in transplant recipients = 15% (skin cancer = 7.5%) compared to 0.5% in the general population. – Solid organ tumors carry ~2 fold risk, whereas skin CA and lymphoma carry >30 fold risk.

AJT 2004; 4: 905–913

Ratio of malignancy rates in transplant recipients vs. general population

? AJT 2004; 4: 905–913

Why are transplant recipients at higher risk for malignancy? • Chronic immunosuppression use places patients at risk for malignancies – Impaired immune surveillance: high rates of CA in patients with congenital immunodeficiencies – Susceptibility to oncogenic viruses: EBV, HSV, hepatits B and C, HPV. – Direct neoplastic properties of immunosuppressive agents.

Risk factors for malignancy (nonskin) after kidney transplant Risk Factor

Relative Risk

P value

Age at transplant 0-17 18-34 35-49 50-64 ≥65

1.62 (1.17–2.24) 1.0 (reference) 1.41 (1.18–1.68) 2.98 (2.51–3.52) 4.93 (4.10–5.94)

.0036 -.0002