Post transplant cancer
Another consequence of immunosuppression is impared cancer surveillance. Although almost all cancers occur, skin cancer and non-Hodgkin’s lymphomas are the most frequent.
Skin cancer of the non-melanomic variety, especially squamous cell cancer, is the most frequent of all cancers. Its incidence increases as the duration of immunosuppression increases. Although metastasis and death from these cancers are uncommon in the general population, they can be fatal in the transplant population.
A serious malignancy that can occur during the first year post-transplant is Post Transplant Lymphoproliferative Disease (PTLD). Most cases result from activation of, or acquired infection with, the Epstein-Barr virus (EBV). Optimal therapy is evolving, but is presently limited to reducing immunosuppressive medications, administering anti-viral agents, and chemotherapy. Consideration should be given to switching from tacrolimus (that increases risk of PTLD) to Sirolimus which has been shown to decrease metastasis and cell growth in non-human studies. Even with optimal therapy, first year mortality approaches 50%.