Kidney Transplant Recipients Risk Cancer, Drugs Are Irrelevant

According to a study published in JASN (Journal of the American Society Nephrology), drugs taken by those persons having received kidney transplant represent similar risks of cancer, no matter their origin. The higher incidence of cancer among these patients cannot be related to any of these drugs particularly, but the medication by itself increases the risk.
Statistics reveal that there is an increased risk of developing cancer for kidney transplant receivers versus the general population. This increased risk is supposed to be due to immunosuppressive medications taken by this kind of patients for a long time in order to prevent organ rejection. Studies conducted by Martin Gallagher, MBBS, The George Institute for International Health in Australia (FRACP) and his team have dealt with transplant patients who had taken part in a randomized clinical trial about twenty years ago, with the declared purpose of outlining the differences in cancer risk related to different immunosuppressive medications.
What researchers had to study was the incidence of the disease among 481 kidney transplant patients in the Australian Multicentre Trial of Cydosporine Withdrawal. Patients have received one of the following three treatment combinations: cyclosporine monotherapy, cyclosporine monotherapy switched to azathioprine and prednisolone therapy after three months, or azathioprine and prednisolone alone.
A number of 226 out of the 481 patients in the trial have developed at least one type of cancer. Within twenty years post transplant, non-skin cancer was developed by 27 percent of patients, while 48 percent of them developed skin cancer. No matter what the type of treatment was, there was no effect on cancer timing or incidence, which means all therapies determine similar risks for developing the disease after kidney transplantation.
Dr. Gallagher admitted that no significant differences in cancer risk were shown that would allow specialists to blame one or the other of the three treatment regimens. The conclusion of the study was that no single immunosuppressive treatment would be responsible for driving the increase in developing cancer for kidney transplant patients.
The study also reveals that there are certain patient characteristics, known at the moment of the transplantation, which significantly influence the risk of cancer. This way, non-skin cancer was associated with previous smoking history and increasing age as well, while skin cancer was related to increasing age, fairer skin, non-brown eyes, and a functioning transplant. Patients presenting a high risk can be more closely monitored and are supposed to use special preventing measures of protection against cancer.
The authors of the study have outlined that immunosuppressive treatments are not the same as twenty years ago. Today’s regimens are certainly better with respect to acute rejection prevention and are more efficient at immunosuppression.
Co-authors of this study include Meg Jardine, MBBS, PhD, FRACP, Vlado Perkovic, MBBS, PhD, FRACP, Alan Cass, MBBS, PhD, FRACP (The George Institute for International Health); Patrick Kelly, PhD, Jonathan Craig, MBBS, PhD (University of Sydney, in Australia); Josette Eris, MBBS, PhD, FRACP (Royal Prince Alfred Hospital, in Camperdown, Australia); and Angela Webster, MBBS, PhD, MRCP (University of Sydney and Australia and New Zealand Dialysis and Transplant – ANZDATA – Registry, in Adelaide, South Australia).
Dr. Gallagher and Dr. Perkovic have benefited from speaking fees from Roche Pharmaceuticals. Dr. Eris has been given travel assistance from and chairs advisory boards of Roche (chair), Novartis, Wyeth, and Janssen-Cilag. She also received travel support from Roche and Novartis during he last three years. Contributions from Novartis, Roche and Wyeth were given to ANZDATA Registry.