Malignancy

Although cancer is a complication of transplantation, one must emphasize that the great majority of organ allograft recipients do not develop this problem. The risk of developing a de novo malignancy is generally not a contraindication to transplantation. Many patients who develop de novo malignancies have readily treatable in situ carcinomas of the cervix, low-grade skin tumors, and in situ carcinomas of the vulva and perineum. However, with the limited experience gained thus far, nonrenal allograft recipients appear to be more prone to develop potentially life-threatening tumors, mainly lymphomas. Their occurrence may be related to the more intense immunosuppressive therapy that the surgeon is forced to give to some patients compared with renal allograft recipients. In these patients efforts to preserve a rejecting kidney may be abandoned in favor of dialysis and cessation of immunosuppressive therapy. A second transplantation can be performed at a later date when the patient has recovered from the effects of heavy immunosuppression. When large numbers of nonrenal allograft recipients have been followed for prolonged periods, it is likely that the pattern of malignancies described in renal allograft recipients will be seen in them as well.