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Managing comorbidities

It is common to have some medical problems after transplant. Many transplant recipients manage two or more diseases at the same time. Some of the most common are:

  • Cancer
  • Diabetes
  • High blood pressure
  • Kidney disease
  • Cardiovascular disease

Cancer is more common in transplant patients than the general population. Research has shown that it is likely for patients who live for at least 10 years after a transplant to develop some type of cancer, including skin cancer.

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Donor related cancers

Although very rare, cancer can be transmitted through deceased and living donor organ, cell and tissue transplantation. Treatment of donor-related tumors consists of changing, reducing or stopping immunosuppressive drug therapy, returning to chronic hemodialysis (for renal recipients) and possible re-transplantation.

Recipients with past history of cancer

Transplant recipients with a history of pre-existing malignancies have a very low incidence of recurrence post-transplant. Recurrence rates are affected by the specific type of cancer, the extent of the disease at treatment, the time elapsed since the treatment and how that type of cancer normally progresses.

Cancer due to suppression of the immune system

Transplant recipients have an increased risk of developing new cancers in general (one to two percent per year) and a 15-20 percent higher incidence of certain types of cancer. Skin cancer and lymphomas (cancers of the lymph glands) are the most prevalent types of cancer seen post-transplantation. The risk of cervical, breast cancer, and colorectal cancer are also increased. Post-transplant patients, have a significantly increased risk of developing squamous cell carcinomas, as well as increased risk for other types of skin cancers, such as melanoma. A smaller number of transplant recipients develop lymphoma within a year of the operation. This cancer is the growth of white blood cells in the body’s immune system. There are several treatment options that require careful assessment by your specialists. Some lymphomas go away if anti-rejection drugs are reduced or stopped, while some will respond to drugs (chemotherapy) or X-ray treatment (radiotherapy). A small number of patients develop non-skin, non-lymphoma cancers. When this occurs, standard cancer treatment options, including surgery, radiotherapy and chemotherapy must be individualized to the patient, and coordinated by the oncologist and transplant surgeon/physician.

Risk factors

The main risk factors contributing to an increased incidence of any cancer is due to suppression of the immune system, and duration and intensity of immunosuppression. In fact, all types of immunosuppressant medications can increase the risk for certain types of cancer. Other risk factors may include:

  • History of cancer
  • Male gender
  • Race
  • Older age

Prevention & early detection

Early detection of cancer leads to better outcomes. Monthly breast, testicular and skin self-examinations are suggested as well as routine medical check-ups. PAP smears, breast exams, testicular exams, and skin cancer screening should be done by your physician every year. Your primary care doctor may perform these tests, but duplicate reports should be sent to your transplant team. Other general measures should also be taken. These include:

  • Reduce sun exposure
  • Stop smoking
  • Follow a balanced diet plan and get enough exercise

Reference and Publication Information

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