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| | | Year : 2010 | Volume : 21 | Issue : 6 | Page : 1044-1047 | | | Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation | | | Abazar Akbarzadehpasha1, Farshid Oliaei1, Mohammad Reza Asrari1, Reza Alizadeh-Navaei2
1 Kidney Transplantation Center, Babol University of Medical Sciences, Babol, Iran
2 Kidney Transplantation Center, Babol University of Medical Sciences, Babol; Research and Technology Department, Mazandaran University of Medical Sciences, Manzadaran, Iran
Click here for correspondence address and email | Date of Web Publication | 4-Nov-2010 | | |      | |  Abstract | | | Long-term immunosuppressive therapy after renal transplantation increases the risk of developing malignancy. The aim of this study was to determine the demographic parameters and immunosupression protocol in kidney transplant recipients with and without malignancy. This case-control study was undertaken on 12 renal transplant recipients with malignancy and 48 without malignancy at The Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Data including age, gender, number of anti-rejection therapies and immunosupression regimen were recorded and analyzed with SPSS and Mann-Whitney Fisher's exact t-test. P value < 0.05 was considered significant. The prevalence of malignancy in 380 renal allograft recipients was 3.15% during six years of follow-up. The malignancies noted after renal transplantation included: Kaposi's sarcoma (n = 5), lymphoma (n = 3), cutaneous basal cell carcinoma (n = 2), cutaneous squamous cell carcinoma (n = 1) and brain tumor (n = 1). Age of patients at the time of transplantation, duration of immunosupression treatment and number of anti-rejection therapies were not significantly different in patients with and without malignancy (P > 0.05). Males were significantly more affected with malignancy compared to females (P < 0.05). Our study shows that there was no significant correlation between age at transplantation, duration of immunosupression treatment and number of anti-rejection therapies and occurrence of post-renal transplantation malignancy; however, the prevalence of malignancy was significantly higher in male patients. The most common malignancy seen was Kaposi's sarcoma followed by lymphoma. How to cite this article:
Akbarzadehpasha A, Oliaei F, Asrari M, Alizadeh-Navaei R. Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation. Saudi J Kidney Dis Transpl 2010;21:1044-7 |
How to cite this URL:
Akbarzadehpasha A, Oliaei F, Asrari M, Alizadeh-Navaei R. Comparison of demographic data and immunosupression protocol in patients with and without malignancy after kidney transplantation. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2014 Mar 3];21:1044-7. Available from: http://www.sjkdt.org/text.asp?2010/21/6/1044/72289 |
| Introduction | |  |
Recipients of kidney transplants are more susceptible to develop cancer. [1],[2],[3] This high incidence has been attributed to the use of immunosuppressive agents to prevent allograft rejection. [4] The incidence of neoplasms among transplant recipients is increasing, being estimated between 4 and 18%. [5] Neoplasms showing increased frequency in this group include: skin cancer, non-Hodgkin's lymphoma, Kaposi's sarcoma, in situ carcinoma of the uterine cervix, anogenital cancer, renal cell carcinoma, hepatocellular carcinoma and a variety of sarcomas. [4],[6],[7] Some well-known factors associated with the development of tumors are genetic factors, smoking, chronic opportunistic infection by oncogenic viruses, older age at transplantation, male gender and long-term immunosuppression. The prevalence of neoplastic disease has been reported to be four to five times higher than that in the general population of similar age and gender distribution. [5],[8],[9] In this study, we reviewed some features of malignancies in renal transplant recipients in the north of Iran.
| Materials and Methods | | |
This is a case-control study. A total of 380 patients underwent renal transplantation from 1999 to 2005 at the Shahid Beheshti Kidney Transplantation Center in Babol (north of Iran). Of them, we analyzed 12 patients with posttransplant malignancy in the case-group and 48 patients without malignancy in the controlgroup. The control group was selected randomly among recipients of living donor transplants who had normal graft function and had completed at least one year after transplantation. Data including age, gender, number of antirejection therapies and immunosupression regimen were recorded from medical records and analyzed with SPSS 11 and t-test, MannWhitney and Fisher's exact tests. P < 0.05 was considered significant.
| Results | | |
The prevalence of malignancy in the 380 renal allograft recipients studied was 3.15% after six years of follow-up. The malignancies noted included: Kaposi's sarcoma (n = 5), lymphoma (n = 3), basal cell carcinoma (BCC) (n = 2), squamous cell carcinoma (SCC) (n = 1) and brain tumor (n = 1). The mean (± SD) age at transplantation was not significantly different in patients with (49.5 ± 13.3 years), and without malignancy (41.1 ± 14.3 years) (P = 0.073). The proportion of males in the malignant patients group (11 males and 1 female) was significantly higher (P = 0.02) than in the nonmalignant subject group (26 males and 22 females).
Duration of immunosupression treatment was not significantly different in patients with and without malignancy (51.4 ± 23.9 months vs 44.2 ± 24.3 months) (P > 0.05). Number of anti-rejection therapies administered was 1.08 ± 0.79 in patients with malignancy and 0.7 ± 0.84 in patients without malignancy (P > 0.05).
Ten subjects in the malignancy group and 42 subjects in the control group had received cyclosporine, prednisolone and azathioprine and two subjects in the malignancy group and six subjects in the control group had received cyclosporine in combination with prednisolone and mycophenolate mofetil (MMF) (P > 0.05). [Table 1] shows that anti-rejection therapy was not significantly different between the two groups (P > 0.05).  | Table 1 :Frequency of anti-rejection medication between malignant and non-malignant subjects after kidney transplantation.
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| Discussion | | |
Malignancies are an important cause of morbidity and mortality among transplant recipients. The prevalence of malignancy in transplant recipients at our center was 3.15% while it was 1.8% in the study of Nafar et al from Iran, [4] 5.8% in the report of Altaee et al from Iraq, [10] 3% reported by Rascente et al from Italy, [5] 10.9% reported by Marcen et al from Spain [11] and 1.5% in the Tang et al study from China. [12] The findings of our study and that of Nafar et al show that the prevalence rate of post-kidney transplant malignancy was lower in Iran than elsewhere. One possible explanation for this finding is the preponderance of living donor kidney transplant recipients in our report, requiring low doses of immunosuppression. In addition, geographical influence and duration of follow-up post-transplantation might be responsible for this difference.
The most common malignancy in the present study was Kaposi's sarcoma, which is similar to the reports of Nafar et al [4] and Altaee et al; [10] however, in other studies, skin cancers were the most frequent. [11],[13],[14],[15]
Age is one of the major risk factors for malignancy after transplantation and in the present study, the mean age of recipients at the time of transplantation was higher in the malignant group than in the non-malignant group, although this difference was not significant. The Italian registry of organ transplant recipients reported a nine-fold increase of skin cancer in transplanted patients above 50 years of age in comparison with those transplanted before 30 years of age. Also, a two-fold increase was seen in transplanted males versus females. [16] In the present study, the proportion of males in the malignant group was significantly higher than in the non-malignant group, which is in agreement with the results of Marcen. [11]
The mean duration of immunosuppressive therapy and number of anti-rejection therapies was higher in the malignant group than the non-malignant group but the difference was not statistically significant.
| Conclusion | | |
Our report suggests that the prevalence of post-transplant malignancy is lower in Iran when compared with other countries and may be related to the high prevalence of living donor kidney transplants. Kaposi's sarcoma was the most frequently encountered malignancy.
| Acknowledgment | | |
The authors wish to thank the kidney transplantation ward personnel for collaboration in this study.
| References | | |
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Correspondence Address:
Reza Alizadeh-Navaei
Kidney Transplantation Center, Shahid Beheshti Hospital, Babol
Iran
PMID: 21060171
[Table 1] | |
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