Lymphoma-the most common neoplasia in renal transplant recipients

Sun protection in Iranian kidney transplant recipients: knowledge, attitude and practice

BACKGROUND

Kidney transplant recipients (KTR) are at increased risk of developing skin cancer. The purpose of this study was to evaluate the knowledge, attitude, and practices of KTRs regarding skin cancer after transplantation and to identify the role of education in motivating these patients to practice sun-protective behaviours.

METHODS

Two hundred and fifty KTRs in a referral hospital were interviewed using a questionnaire. All patients received a skin cancer information booklet after completion of the questionnaire. Six months later, these patients were invited and interviewed again about their skin cancer-prevention practices.

RESULTS

The patients consisted of 153 men and 97 women patients with a mean age of 35.9 +/- 14.2 years and mean of 49.7 +/- 53.1 months after their transplantation. A total of 102 patients (40.8%) mentioned receiving skin care advice after transplantation. Nonetheless, the majority of patients did not have appropriate skin cancer-prevention practices. Patients who had received advice on skin care after transplantation were significantly more likely to do skin self-examination (chi-squared test; P < 0.001) and have less sun exposure daily (Mann-Whitney test; P = 0.019) than those who did not. Half of the patients (125 patients) participated in the second part of the study 6 months after the first interview and providing skin care instruction booklet. Although regular skin self-examination and sunscreen use was significantly increased (P = 0.006 and P = 0.001, respectively), but daily sun exposure was not changed significantly (P = 0.64).

CONCLUSIONS

Post-transplantation education does not necessarily lead to patients' awareness about their increased risk of skin cancer, and subsequent motivation to practice effective sun protection. Health professionals and dermatologists in particular need to establish better methods of dissemination of information, repeatedly and at the proper time.

Racial and ethnic variations in incidence and pattern of malignancies after kidney transplantation

Malignancies are a well-recognized complication of renal transplantation. Although the problem is well studied in developed countries, less is known about it in developing countries. Although geographic and ethnic variations have been alluded to in several reports, to our knowledge the subject has not been investigated formally. From April 1976 through March 1999, 41 (7.6%) patients were diagnosed with cancer among a heterogeneous population of renal allograft recipients treated at our institution in Cape Town, South Africa. The incidence of malignancies was comparable in white and nonwhite patients. However, squamous cell cancer and basal cell cancer of the skin (in that order) were the most common cancers in white patients, in whom they occurred exclusively. On the other hand, Kaposi sarcoma was the most common cancer in nonwhite renal allograft recipients, in whom it accounted for almost 80% of all cancers. Review of the world literature suggests that posttransplant cancers are less common in developing countries; Kaposi sarcoma is the most common lesion, with few exceptions. Malignant lymphomas are also more common in developing countries. The impact of different immunosuppressive regimens is controversial. In general, cyclosporine is not associated with a significant increase in the incidence of cancer after renal transplantation, although the time to the first cancer may be reduced. In our experience, the pattern of posttransplant cancers in white and nonwhite patients living in the same geographic region epitomizes the world experience of the disease and suggests that genetic factors, rather than geography, are the more important determinants of cancer development after renal transplantation.

Treatment results in renal transplant recipients with non-Hodgkin's lymphoma

The purpose of this study was to investigate the incidence of non-Hodgkin's lymphoma (NHL), response to treatment, and survival time in renal transplant recipients at our center who developed this form of neoplasia. Between October 1985 and August 2002, 1077 renal transplantations were carried out at our center. The incidence of NHL after transplantation was 1.1% (12/1077). All patients had their immunosuppressive doses reduced after they were diagnosed with NHL. Complete remission was achieved in eight cases, and five of these individuals were still alive at the time of writing. The circumstances for each of the three deaths in this group were as follows: (1) progressive gastric adenocarcinoma 9 years after being diagnosed with NHL, (2) stage III NHL cured with chemotherapy, but died of infection 2 years after NHL diagnosis, and (3) recurrent intestinal lymphoma, with death during second line chemotherapy. Of the five survivors in the remission group, one had to return to hemodialysis. The four patients who did not enter remission all died. The median time from transplantation to diagnosis of NHL was 66 months. At the time of writing, the median survival time for the eight patients who achieved complete remission was 41.5 months. The study showed that treatment of localized disease (skin or intestinal NHL) with surgery and/or radiotherapy/chemotherapy leads to complete remission and long survival times; however, patients in remission are at risk for other causes of death.

Continued transplant immunosuppression may prolong survival after return to peritoneal dialysis: results of a decision analysis

BACKGROUND

Patient survival is prolonged in those with residual renal function. The risks of opportunistic infection and malignancy militate against a widespread policy of maintaining immunosuppression in those returning to peritoneal dialysis after a failed allograft. We set out to test the hypothesis that patients returning to peritoneal dialysis after a failed transplant benefit from continued immunosuppression.

METHOD

A decision analytic model comparing the use of immunosuppression after transplant failure and return to peritoneal dialysis with immunosuppressive withdrawal. Two assumptions were made: that the survival benefit reported in patients with a transplant kidney was the same as that expected from a native kidney with a similar glomerular filtration rate (GFR) and that the risks of carcinoma and opportunistic infections were equal to that of the general population if immunosuppressive therapy was discontinued. Probabilities were obtained from the literature, from an administrative database, and from the rate of GFR decline seen in our own unit in patients returning to dialysis who had been discontinued from their transplant immunosuppressive medication.

RESULTS

Life expectancy was prolonged from 5.3 years to 5.8 years when immunosuppression was continued in patients who returned to dialysis after chronic allograft failure. A higher survival benefit was seen at higher levels of additional GFR. A benefit from continued immunosuppressive therapy was seen for all values of additional GFR greater than 15 L/wk. All dialysis and renal clearances have been expressed as L/wk. The conversion factors for conversion to mL/s and mL/min are 605 and 10.1.

CONCLUSION

The data suggest that there may be a survival advantage in maintaining patients on long-term immunosuppressive function even after they return to peritoneal dialysis after allograft failure.