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About post-transplant cancer (PTC)
Organ transplant recipients are at a higher risk of developing cancer. The overall risk of cancer for transplant recipients is 2- to 3-times higher compared to the general population of the same age and sex.
Risk factors of post-transplant cancer
The reasons for transplant recipients’ increased risk of cancer include:
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The use of immunosuppressants for anti-rejection therapy
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Pre- or post-transplant exposure to viruses associated with cancers
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General risk factors such as age, sex, history of smoking or drinking, prior cancers, and other underlying conditions
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The risk of post-transplant cancer is ∼40% higher for people who have had a prior cancer. For example, liver cancer is often a reason for a liver transplant. Such transplant recipients are thus at a higher risk of cancer.
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Skin cancer
Transplant recipients are at a very high risk of developing skin cancers, especially nonmelanomas.
Compared to the general population, transplant recipients are about:
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100 times more likely to develop squamous cell skin cancer
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50 times more likely to develop Kaposi sarcoma
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10 times more likely to develop basal cell skin cancer
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4 times more likely to develop melanoma
While basal cell cancer is the most common type of skin cancer in general, squamous cell cancer is the most common cancer in transplant recipients.
Learn more:
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Mittal, A., Colegio, O.R. (2017). Skin Cancers in Organ Transplant Recipients. American Journal of Transplantation, 17(10), 2509-2530.https://doi.org/10.1111/ajt.14382
Post-transplant lymphoproliferative disorder (PTLD)
Post-transplant lymphoproliferative disorder (PTLD) is a term used to describe a group of post-transplant diseases that are caused by the uncontrolled growth of lymphocytes.
Most cases of PTLD are associated with the Epstein-Barr virus (EBV). About 80% of PTLDs are caused by B-cell proliferation induced by EBV. The other 20% of PTLDs are caused mainly by T cells. Some cases of PTLD are not associated with EBV, but these types of PTLDs are not well understood.
Learn more:
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Leukemia & Lymphoma Society – Post-Transplant Lymphoproliferative Disorders fact sheet
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Samant, H., Vaitla, P., & Kothadia, J. P. (2023). Posttransplant lymphoproliferative disorders. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513249
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Petrara, M. R., Giunco, S., Serraino, D., Dolcetti, R., & De Rossi, A. (2015). Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment. Cancer Letters, 369, 37–44. https://www.sciencedirect.com/science/article/pii/S0304383515005364
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Kotton, C.N. et al. (2016). Transplant Infectious Diseases: A Review of the Scientific Registry of Transplant Recipients Published Data. American Journal of Transplantation, 17(6), 1439 – 1446. https://www.amjtransplant.org/article/S1600-6135(22)25005-9/fulltext
Virus-related cancers
Transplant recipients are vulnerable to viral infection or reactivation of latent infection due to their suppressed immune system as a part of anti-rejection therapy.
Viruses that can lead to cancer include:
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Epstein-Barr virus (EBV)
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Human herpes virus 8 (HHV-8)
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Human papillomavirus (HPV)
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Merkel cell polyomavirus
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Hepatitis B
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Hepatitis C
Learn more:
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Schiller, J. T., & Lowy, D. R. (2021). An Introduction to Virus Infections and Human Cancer. Recent results in cancer research, 217, 1–11. https://pmc.ncbi.nlm.nih.gov/articles/PMC8336782
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Kotton, C.N. et al. (2016). Transplant Infectious Diseases: A Review of the Scientific Registry of Transplant Recipients Published Data. American Journal of Transplantation, Volume 17(6), 1439 – 1446. https://www.amjtransplant.org/article/S1600-6135(22)25005-9/fulltext
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Kotton, C.N. et al. (2016). Transplant Infectious Diseases: A Review of the Scientific Registry of Transplant Recipients Published Data. American Journal of Transplantation, 17(6), 1439 – 1446. https://www.amjtransplant.org/article/S1600-6135(22)25005-9/fulltext
About post-transplant cancer (PTC)
By cancer type
These cancers have a very large increased risk in transplant recipients (compared to general population):
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Skin cancers
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Squamous cell skin cancer (100 times more likely)
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Kaposi sarcoma (>50 times more likely)
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Basal cell skin cancer (10 times more likely)
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Post-transplant lymphoproliferative disease (PTLD) (>8 times more likely)
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Vaginal, cervical, vulval, anal, and penile cancer (>4 times more likely)
These cancers happen moderately frequently in the general population, so their small relative increase is clinically important:
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Melanoma (~2 times more likely)
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Colorectal cancer (∼40% more likely)
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Lung cancer (>50% more likely)
Many other cancers show a significantly increased risk for transplant recipients, including:
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Head and neck
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Thyroid
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Esophagus
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Stomach
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Leukemias
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Plasma cell tumors
Cancers that do not show an increased risk for transplant recipients are:
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Breast cancer
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Prostate cancer
By transplant type
Although the overall risk for cancer is similar across organ recipients, the incidence of some cancers varies by transplant type:
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PTLD risk is greater for lung and heart recipients than other solid organ recipients
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The risk for kidney cancer is greatest for kidney recipients (~8 times more likely)
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The risk for lung cancer risk is greatest for lung recipients (~5 times more likely)
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The risk for liver cancer risk is greatest for liver recipients
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However, liver cancer is an indication for liver transplantation, so this interpretation is not straightforward as the liver cancer may be recurrent
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About post-transplant cancer (PTC)
If you have a patient who is a transplant recipient, the most important thing you can do is to let them know they have a higher chance of developing cancer.
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To help them learn about post-transplant cancer, share our website with them TRIO PTC
Once they know about post-transplant cancer, encourage them to:
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Follow cancer screening guidelines for their age
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Share resources, such as: https://www.cancer.org/cancer/screening/screening-recommendations-by-age.html#all-ages
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Lower their chance of skin cancer by:
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Being safe in the sun, such as wearing sunscreen
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Share resources, such as: https://www.cancer.org/cancer/risk-prevention/sun-and-uv.html
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Doing skin self-exams
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Visiting a dermatologist twice a year and more for any suspicious moles or concerns
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Follow healthy habits to lower their overall chance of cancer, such as:
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Making healthy choices, such as eating healthy, being active, and avoiding smoking, vaping, and alcohol
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Share resources, such as: https://www.cdc.gov/cancer/prevention/healthy-choices.html
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Lowering their chance of infection
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Share resources, such as: https://www.myast.org/findyourvoice/how-do-i-stay-healthy-after-my-transplant
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Resources
About post-transplant cancer
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Chapman, J. R., Webster, A. C., & Wong, G. (2013). Cancer in the transplant recipient. Cold Spring Harbor perspectives in medicine, 3(7), a015677. https://doi.org/10.1101/cshperspect.a015677
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Gogna, S., Ramakrishna, K., & John, S. (2023). Posttransplantation cancer. In StatPearls [Internet]. StatPearls Publishing. Available from https://www.ncbi.nlm.nih.gov/books/NBK537256
About virus-related cancers
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Schiller, J. T., & Lowy, D. R. (2021). An Introduction to Virus Infections and Human Cancer. Recent results in cancer research, 217, 1–11. Available from https://pmc.ncbi.nlm.nih.gov/articles/PMC8336782
About PTLD
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Leukemia & Lymphoma Society – Post-Transplant Lymphoproliferative Disorders fact sheet
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Samant, H., Vaitla, P., & Kothadia, J. P. (2023). Posttransplant lymphoproliferative disorders. In StatPearls [Internet]. StatPearls Publishing. Available from https://www.ncbi.nlm.nih.gov/books/NBK513249
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Petrara, M. R., Giunco, S., Serraino, D., Dolcetti, R., & De Rossi, A. (2015). Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment. Cancer Letters, 369, 37–44. Available from https://www.sciencedirect.com/science/article/pii/S0304383515005364