Epidemiology of Cancers After Kidney Transplantation and Role of Viral Infections

Kidney transplantation (KT) is an increasingly used medical procedure for treating otherwise fatal end stage renal diseases (ESRD); this success was obtained with the use of potent immunosuppressive agents able to reduce the risk of rejection of transplanted organs, but exposing patients to an increased risk of opportunistic diseases such infections or cancers, this latter representing nowadays the second major cause of morbidity and mortality after KT. KT recipients (KTR) experience a 2- to 4-fold increase of de novo post-transplant malignancies (PTM) when compared to the general population, particularly skin cancers, urological malignancies and virus-related cancers such as non- Hodgkin lymphoma (NHL) or Kaposi’s sarcoma (KS) with up to 100-fold augmented risk when compared to the general population. Given the improved graft and patient survival that have lengthened the observation period for the natural history of immunosuppressed recipients and their increasing age, we can expect that over the next decades mortality from malignancy may represents the leading cause of death in transplanted patients. As the immunosuppression per se and various potentially oncogenic viruses play a major role in cancer development after transplant, a better definition of this phenomenon can lead to the adoption of preventive measure to reduce the risk of PTM or the implementation of better screening protocols to earlier detect malignancies. This chapter examines, from an epidemiological point of view, the incidence, etiology and prognosis of malignancies after kidney transplantation with a focus on those associated with viral infections..

Keywords: Post-Transplant Malignancies, Viruses and Cancer, Kaposi’s Sarcoma, Epstein-Barr Virus, Post- Transplant Lymphoproliferative Disorders, Skin Cancer, Renal Cell Carcinoma, Everolimus, Sirolimus.