OH Post-Transplant Malignancies Physicians should be aware of an increased risk of certain cancers that occurs in states of severe and prolonged immunodeficiency. The overall incidence of cancer in organ transplant patients is increased 3 to 4 fold. The Cincinnati Transplant Tumor Registry has data on 11,966 types of cancer that developed in 11,239 transplant patients.
Tumors appear a relative short time after transplantation.
The earliest tumors are KS and PTLD which appear at a median time of 12 months after transplantation while the latest appearing tumors are anogenital carcinomas that present at a median of 114 months after transplantation. Reduction of immunosuppression per se has been successful in some patients with KS or PTLD, but has rarely been of benefit in patients with epithelial tumors. It carries the risk of organ rejection with potentially fatal consequences in nonrenal allograft recipients. If cancer chemotherapy is necessary administration of azathioprine, cyclophosphamide or mofetil mycophenolate should be suspended because of the risk of severe bone marrow suppression. The cytotoxic agents are themselves immunosuppressive and may prevent allograft rejection.