Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul;37(6):1653-1659.
doi: 10.1007/s40620-024-01978-9. Epub 2024 Jun 7.

High malignancy rate in the absence of viral prophylaxis after kidney transplantation in Sudan

Sarra Elamin  1 , Selma S Ibrahim  2 , Hatim Mudawi  3 , Sara E A Mohamed Ali  3 , Ali Abdel-Satir  4 , Ayman F A Foad  5
Affiliations

High malignancy rate in the absence of viral prophylaxis after kidney transplantation in Sudan

Sarra Elamin et al. J Nephrol. 2024 Jul.

Abstract

Background: Kidney transplantation in Sudan is funded by the government. Cytomegalovirus prophylaxis is provided for patients who receive biological induction or have recipient-negative donor-positive cytomegalovirus serology. Doctor Selma Center for Kidney Diseases joined the national kidney transplant program in May 2019. Since then, we observed the frequent occurrence of cancer in patients who received modest immunosuppression without viral prophylaxis.

Methods: We retrospectively divided kidney transplant recipients between 2019 and 2021 into two groups according to cytomegalovirus prophylaxis and compared tumor occurrence rates.

Results: The first group included 77 patients who did not receive biological induction or cytomegalovirus prophylaxis. The second group included 92 patients who received valganciclovir for 3-6 months. There was no other antiviral treatment except entecavir for chronic hepatitis B virus infection in eight patients. Five patients in the first group developed malignancy. The first patient presented eight months post-transplant with Kaposi sarcoma of the stomach and responded to treatment with sirolimus. The second patient presented nine months post-transplant with cutaneous Kaposi sarcoma and also responded to sirolimus. Two patients presented two and four months post-transplant with aggressive non-cutaneous Kaposi sarcoma that involved the gastrointestinal tract and lymphatic system and died soon afterwards. The fifth patient presented three years post-transplant with non-Hodgkin lymphoma of the duodenum and is currently receiving chemotherapy. Malignancy rate (6.5% vs 0.0%, P = 0.02) and Kaposi sarcoma rate (5.2% vs 0.0%, P = 0.04) were significantly higher in the first group.

Conclusion: In Sudan, omitting valganciclovir prophylaxis after kidney transplantation was associated with a high rate of virus-induced malignancy.

Keywords: Epstein Barr virus (EBV); Kaposi sarcoma; Kaposi sarcoma herpes virus (KSHV); Kidney transplant; Non-Hodgkin lymphoma; Sudan; Valganciclovir; Virus-induced malignancy.

PubMed Disclaimer

References

    1. Oh J, Weiderpass E (2014) Infection and cancer: global distribution and burden of diseases. Ann Glob Health 80(5):384–392 - DOI - PubMed
    1. Cesarman E, Damania B, Krown SE et al (2019) Kaposi sarcoma. Nat Rev Dis Primers 5:9. https://doi.org/10.1038/s41572-019-0060-9 - DOI - PubMed - PMC
    1. Fu L, Tian T, Wang B, Lu Z, Gao Y, Sun Y, Lin Y, Zhang W, Li Y, Zou H (2023) Global pattern and trends in Kaposi sarcoma incidence: a population-based study. Lancet Glob Health 11:e1566–e1575 - DOI - PubMed
    1. McCaughan JA, Courtney AE (2015) The clinical course of kidney transplant recipients after 20 years of graft function. Am J Transplant 15(3):734–740 - DOI - PubMed
    1. Frances C, Marcelin AG, Legendre CH, Chevret S, Dussaix E, Lejeune J, Euvrard S, Bigorie A, Schulz TF, Agbalika F, Lebbe C (2009) The impact of preexisting or acquired Kaposi sarcoma herpesvirus infection in kidney transplant recipients on morbidity and survival. Am J Transplant 9(11):2580–2586 - DOI - PubMed

LinkOut - more resources