TUESDAY, Nov. 1 (HealthDay News) -- Organ transplant recipients
in the United States double their risk of developing cancer
compared to the general population. And that risk is elevated for
32 different types of cancer, according to new research.
In any given year, however, the risk of developing cancer after
a transplant is just 0.7 percent. And experts say the benefits of
transplantation far outweigh such risk.
"People need to understand that transplantation is one of the great success stories of medicine. It's a very effective treatment for people with severe organ disease," explained the study's lead author, Dr. Eric Engels, a senior investigator in the infections and epidemiology branch of the division of cancer epidemiology and genetics at the U.S. National Cancer Institute in Rockville, Md.
"Our study is saying that this population has a unique pattern of cancer risk. Transplant recipients need to be carefully screened and followed," Engels added.
Results of the study are published in the Nov. 2 issue of the
Journal of the American Medical Association.
In 2010, almost 30,000 solid-organ transplants were performed in
the United States, according to background information in the
article. Kidney transplants accounted for more than half of that
total, followed by livers, hearts and lungs.
After transplant, the recipient must take powerful immune
system-suppressing medications to prevent the new organ from being
But those medications put transplant recipients in a catch-22
situation, said Dr. Darla Granger, director of the pancreatic
transplantation program at St. John Hospital and Medical Center in
Detroit. "Suppressing the immune system does increase the risk of
cancer. And, if you have cancer, you want a strong immune system to
fight the cancer," she added.
Another issue with the immunosuppressants is cancers that are
related to viruses. For example, non-Hodgkin and Hodgkin lymphomas
are linked to the Epstein-Barr virus, while cervical and several
other types of cancers are caused by the human papillomavirus, and
some liver cancers are caused by hepatitis B or C viruses.
"We've always known that certain tumors are increased after transplantation. Certain tumors are known to be related to viruses, so when we give immunosuppressant drugs, we're decreasing the body's ability to fight off viruses," explained Dr. Lewis Teperman, chief of transplant surgery at NYU Langone Medical Center in New York City.
Not all of the cancers can be linked to immunosuppression,
however. In some cases, especially with liver and lung cancers,
it's possible that a tiny cancer was present in the body before
"It's hard to sort out the exact cause of cancer, but some are clearly related to being immunosuppressed," Granger said.
Engels' study reviewed data from nearly 176,000 solid organ
transplants done between 1987 and 2008.
The investigators found the overall incidence of cancer was 2.1
times higher than would be expected in a non-transplant
The risk of non-Hodgkin lymphoma was increased more than
sevenfold. The rates of lung and liver cancer were also
significantly increased, but Engels said this may be due to
previous cancers. For example, a treatment for some liver cancers
is a liver transplant, and it's possible that some cancer cells may
survive the transplant process. The risk of lung cancer was highest
in those who received a lung transplant, and the risk of liver
cancer appeared to be elevated only in those who received a liver
The incidence of kidney cancer was increased in all transplant
recipients by almost five times, according to the study. The
researchers said this might be due to the underlying disease
process in people who need new kidneys, and that the
immunosuppressants likely play a role for all transplant
"This study raises some very good points. It suggests that screening for viruses should be done, and that we should always be trying to use less immunosuppressants. It also raises the inclination to screen transplant recipients for tumors," Teperman said.
"This is an important paper, but I think it may overstate the risk. I think the risk of cancer is elevated, but it's probably less than seen here," he added.
For someone who's had a transplant or is waiting for one,
Granger noted, "decrease the risk factors you can. Don't smoke.
Follow good health practices. Wear sunscreen. And, if you've had a
transplant, get the screenings your doctor recommends."
Learn more about post-transplant cancer from the
United Network for Organ Sharing (UNOS).
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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