Tumors, after cardiovascular diseases, are the second cause leading to death in kidney transplant patients.
Solid tumors have increased incidence in transplant population than in general population.
We retrospectively analyzed solid de novo tumors in kidney transplant patients since 1995 to 2010 at the Centre of Udine, finding that urogenital cancer and gastrointestinal cancer were the most occurring solid cancers. Those tumors were responsible of more than 50% of de novo solid tumors with 22% of mortality for urogenital cancer and 41% mortality for gastrointestinal cancer.
We found two factors related to increased occurrence of solid de novo tumors: age and the disease (if glomerulonephritis) which lead to renal failure before kidney transplantation.
Concerning the pretransplant study, If the median time for kidney transplant is 16 months at the moment, few patients with previous failed transplant and immunological particular status can stay waiting for a longer period (that means a longer period since the pretransplant study)
More over what was surprising was the aggressiveness of some de novo solid tumors, leading in a few cases to late diagnosis (for the advanced diseases), despite the careful scheduled follow up.
We would suggest that a possible improvement in early diagnosis and prevention could be the result of a personalized program starting with the pretransplant medical hystory and going through the perioperative period and the late follow up. So we would design for each patient a unique risk assessment, including pretransplant medical hystory, habits and exposure, perioperative events and post transplant follow up.
In conclusion, we sugget to evaluate a personal oncological risk for each patient, starting before transplantation in order to design a tailored pre-peri and post transplant program to increase early detection of "more occurrent", "predictable" and "curable" tumros to ameliorate long term survival.
