SHEIL ET ALll
CANCER FOLLOWING RENAL TRANSPLANTATION
CANCER FOLLOWING RENAL TRANSPLANTATION’ A. G. R. SHEIL, J. F. MAHONEY, J. S. HORVATH, J. R. JOHNSON, D. J. TILLER, G. E. KELLY and J. H. STEWART. Department o f Surgery, University of Sydney; and Renal Units of Sydney Hospital and Royal Prince Alfred Hospital.
Ninety-nine (21%) of 471 patients who survived with functioning grafts for at least six months following renal transplantation developed cancer. Of these 76 (77%) had skin malignancy, 29 (29%) had malignancy affecting other organs, and six had cancer of boti. ;kin and other organs. In patients with skin cancer squamous cell carcinoma (SCC) was three times as frequent as basal cell carcinoma (BCC). SCC tended to be multiple, recurrent and aggressive. Seven (12%) patients with SCC developed metastases of whom five died. Cancers other than skin included reticulum cell sarcoma (9), acute leukaemia (2) and cancers involving the gastrointestinal (5), genitourinary (11) and respiratory (2) systems. Incidence of cancer in patients surviving beyond one, five and nine years after operation was 98/428 (23%), 70/179 (39%) and 20/45 (44%) respectively. In 31 patients who died more than five years after transplantation cancer was the major cause in eight (26%). For the types of cancers recorded estimates show allograft recipients to be at increased risk when compared with the agematched Australian population by factors which varied from 300 times for reticulum cell sarcoma to 1.8 times for invasive carcinoma of the cervix. The full extent of the threat of cancer in immune suppressed transplant recipients remains to be determined. ALTHOUGH ten years have passed since the first reports of cancer following renal transplantation (Doak etalii, 1968; Woodruff, 1969), theextent of this threat remains undetermined. Penn (1975) calculated the incidence of de novo cancer development in allograft recipients to be 5.6%, or approximately 100 times greater than that of the age-matched general population. However, frequency of cancer increases with time after transplantation (Sheil, 1977) and there is marked increase in incidence in areas at “high risk” for skin cancer. In Australia Marshall (1974) reported that 28% of survivors four or more years after transplantation developed premalignant skin lesions and 17% developed skin cancer. In a cumulative study from the same area Sheil (1977) reported a total incidence of cancer in 1. The Study was supported by the University of Sydney Cancer Research Fund, the New South Wales State Cancer Council, and the Postgraduate Committee in Medicine. The University of Sydney.
Reprints: Professor A. G. R. Sheil. Department of Surgery, University of Sydney, Sydney, N.S.W. 2006, Australia.
AUST. N.Z.J. SURG. VOL. 49 - No. 6, DECEMBER, 1979
patients surviving more than four years posttransplant of 23%. Here we review the current occurrence of cancer in patients who received renal allografts in the care of the University of Sydney Transplantation Unit and the Renal Units of Royal Prince Alfred Hospital and of Sydney Hospital. PATIENTS AND METHODS
All recipients of renal allografts who survived with functioning grafts for at least six months following renal transplantation were assessed. Selection and management of donors and recipients, tissue matching methods, and immune suppressiveagents used have been reported in detail (Sheil etalii, 1972). Briefly, azathioprine (3mg/kg) and prednisone (10mg/kg, reducing steadily) were administered to all patients. Drug dosages were reduced or therapy was stopped if leucopenia, infections, or other manifestations of drug toxicity developed. Eighty per cent of all patients were treated with6-lOmg/kg/day 617
CANCER FOLLOWING RENAL TRANSPLANTATION
CANCER FOLLOWING RENAL TRANSPLANTATION’ A. G. R. SHEIL, J. F. MAHONEY, J. S. HORVATH, J. R. JOHNSON, D. J. TILLER, G. E. KELLY and J. H. STEWART. Department o f Surgery, University of Sydney; and Renal Units of Sydney Hospital and Royal Prince Alfred Hospital.
Ninety-nine (21%) of 471 patients who survived with functioning grafts for at least six months following renal transplantation developed cancer. Of these 76 (77%) had skin malignancy, 29 (29%) had malignancy affecting other organs, and six had cancer of boti. ;kin and other organs. In patients with skin cancer squamous cell carcinoma (SCC) was three times as frequent as basal cell carcinoma (BCC). SCC tended to be multiple, recurrent and aggressive. Seven (12%) patients with SCC developed metastases of whom five died. Cancers other than skin included reticulum cell sarcoma (9), acute leukaemia (2) and cancers involving the gastrointestinal (5), genitourinary (11) and respiratory (2) systems. Incidence of cancer in patients surviving beyond one, five and nine years after operation was 98/428 (23%), 70/179 (39%) and 20/45 (44%) respectively. In 31 patients who died more than five years after transplantation cancer was the major cause in eight (26%). For the types of cancers recorded estimates show allograft recipients to be at increased risk when compared with the agematched Australian population by factors which varied from 300 times for reticulum cell sarcoma to 1.8 times for invasive carcinoma of the cervix. The full extent of the threat of cancer in immune suppressed transplant recipients remains to be determined. ALTHOUGH ten years have passed since the first reports of cancer following renal transplantation (Doak etalii, 1968; Woodruff, 1969), theextent of this threat remains undetermined. Penn (1975) calculated the incidence of de novo cancer development in allograft recipients to be 5.6%, or approximately 100 times greater than that of the age-matched general population. However, frequency of cancer increases with time after transplantation (Sheil, 1977) and there is marked increase in incidence in areas at “high risk” for skin cancer. In Australia Marshall (1974) reported that 28% of survivors four or more years after transplantation developed premalignant skin lesions and 17% developed skin cancer. In a cumulative study from the same area Sheil (1977) reported a total incidence of cancer in 1. The Study was supported by the University of Sydney Cancer Research Fund, the New South Wales State Cancer Council, and the Postgraduate Committee in Medicine. The University of Sydney.
Reprints: Professor A. G. R. Sheil. Department of Surgery, University of Sydney, Sydney, N.S.W. 2006, Australia.
AUST. N.Z.J. SURG. VOL. 49 - No. 6, DECEMBER, 1979
patients surviving more than four years posttransplant of 23%. Here we review the current occurrence of cancer in patients who received renal allografts in the care of the University of Sydney Transplantation Unit and the Renal Units of Royal Prince Alfred Hospital and of Sydney Hospital. PATIENTS AND METHODS
All recipients of renal allografts who survived with functioning grafts for at least six months following renal transplantation were assessed. Selection and management of donors and recipients, tissue matching methods, and immune suppressiveagents used have been reported in detail (Sheil etalii, 1972). Briefly, azathioprine (3mg/kg) and prednisone (10mg/kg, reducing steadily) were administered to all patients. Drug dosages were reduced or therapy was stopped if leucopenia, infections, or other manifestations of drug toxicity developed. Eighty per cent of all patients were treated with6-lOmg/kg/day 617
