[Solid tumors after kidney transplantation]

Abstract

The overall risk of cancer in the kidney transplant patient is three to five times higher than the risk in the general population, and the risk of cutaneous epitheliomas, the most frequent, is multiplied by 100. There are many causes of posttransplantation cancer involving modifications in the immunosurveillance of neoplastic cells, viral reactivation or an increase in viral infections, genetic or acquired risks, but also immunosuppressors. Azathioprine and anticalcineurins in particular are associated with an increase in cancer risk. This is why at-risk patients should be monitored closely before and after transplantation. During the pretransplantation period, the risk factors present should be eradicated and the patient screened for cancers. In the posttransplantation period, prevention is indispensable, with regular screening for cancer, sun protection, and induction treatment adapted to the risk present. In transplantation patients who have developed cancer, immunosuppression can, however, be preserved using proliferation signal inhibitors, which present useful anti-tumor activity at doses that are effective for immunosuppression. Effective treatment of the cancer can now be expected without systematically losing the graft after interrupting the transplantation treatment.