Introduction: Renal transplantation is the standard of care and most cost effective treatment option for end stage kidney disease1-2. It significantly improves life expectancy and offers better quality of life to these patients. However, the use of potent immunosuppressive drugs predisposes this population to develop various cancers, which are one of the leading causes of morbidity and mortality3-5. Post-transplant malignancy ranks the third most common cause of death in renal transplant recipients6. The aim of this study was to observe the spectrum of post-transplant malignancies and their clinical characteristics over a period of 40 years.
Method: This retrospective study was carried out at SIUT, Karachi, Pakistan. All renal transplant recipients (n=7090) were included from November 1983 to December 2023 (40 years). The original biopsy forms and case files of all transplant recipients who developed post-transplant malignancies were reviewed and relevant clinical, demographic and pathological data were retrieved and analyzed. SPSS version 10.0 was used for statistical analysis.
Results: Overall, 7090 renal transplants were carried out during the study period. Among these, 212 (2.9%) patients developed malignancies. There were 191 males (90.1%) and 21 females (9.9%) with a mean age of 32.07±10.23 years (range: 2-60 years). Mean duration of Hemodialysis pre transplant was 7.57±10.46 months (range: 1-84). Majority of patients had 3-5 Antigen match (n=148, 69.8%) while 20 patients had only 0-2 Antigen match (9.4%). Induction with ATG was done in 11 patients (5.2%). Steroids were given in all patients (100%) in combination with Cyclosporine and Azathioprine for maintenance immunosuppression in majority of patients (n=202, 96.3%). Episodes of Rejection were observed in 46 patients (21.7%). Mean duration of time from transplantation to development of malignancy was 8.11±5.00 years (range: 0-21.5). The most common type of malignancy was Lymphoma (n=102, 48.11%) followed by skin and mucosal malignancies (n=40, 18.86%) followed by adenocarcinomas of various sites (n=30, 14.1%), transitional cell carcinoma and renal cell carcinoma (each n=10, 4.71%), Kaposi sarcoma (n=8, 3.71%).
Conclusion: In conclusion, post-transplant malignancy incidence rate is relatively low in our study as compared to those reported from other parts of western world. Lymphoma remains the most common cancer type followed by skin and mucosal malignancies. There is a decrease in the prevalence of Kaposi sarcoma and this finding is concordant with the other studies.