Chapter 16: Cancer in Solid Organ Transplantation

Solid organ transplantation provides lifesaving therapy for patients with end-organ disease. The Scientific Registry of Transplant Recipients (SRTR) report announced that 17,654 kidney, 6455 liver, 1946 lung, 2554 heart, and 109 intestinal transplants were performed in 2013, superseding the number of transplants from prior years (1). It also reports continual improvement in death-censored graft survival (2,3). Success of field of transplantation is reflected in the rising number and longevity of the transplant organs. However, the same report also noted an increase in recipient death with graft function, primarily due to increased infections and cancers associated with chronic immunosuppression. Malignancy is the second leading cause of death with graft function (4). The risk of cancer is twoto four-fold higher in transplant recipients than age-, sex-, and race-matched individuals from similar geographic areas (5,6). Not only are cancers common, but they tend to be more aggressive and are associatedwith increasedmortality among transplant recipients than in the general population. The relative risk varies by age. Children have the highest increase (15–30 times), and older individuals (i.e.,.65 years of age) experience a two-fold increase. The magnitude of increase in risk for all cancer types is similar across organ recipients; the incidence of specific cancer varies by transplanted organ. Knowledge of cancer types, including the magnitude of increased risk and its clinical course, can help develop prevention and early detection protocols and prompt management (including adjustment of immunosuppression) to minimize cancer related deaths.