Transplant recipients with a history of a malignancy: risk of recurrent and de novo cancers

A review is presented of outcomes of kidney and heart transplant recipients who had a history of a preexisting malignancy. Reasons for differences in recurrent malignancy rates reported by the Cincinnati Transplant Tumor Registry and the Australia/New Zealand Registry are discussed. Data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database indicated that 2.1% of 65 999 kidney and 3.0% of 18 954 heart recipients had a preexisting malignancy with 31 recurrences (2.3%) in kidney and 16 recurrences (2.8%) in heart recipients. De novo malignancies in kidney and heart recipients with a past malignancy were significantly greater (P < .0001) than that of recipients with no past history. The low incidence of recurrence in the United Network for Organ Sharing data made it difficult to evaluate the relative risk of developing a recurrence. Therefore, a review of the literature for the incidences of late recurrences (>5 years) of treated malignancies in nontransplant patients was made to provide a perspective on the risks of recurrence of these tumors. The specific malignancies reviewed included renal carcinoma, malignant melanoma, carcinoma of the lung, breast, colon, thyroid, seminoma and other testicular tumors, prostate cancer, Hodgkin's, and non-Hodgkin's lymphoma. Finally, a discussion of prevention and treatment of recurrent malignancies in transplant patients is made.