Post-transplant malignancy: Reducing the risk in kidney transplant recipients

Introduction: The growing and aging of the end-stage kidney disease population, and improvements in short-term kidney transplant outcomes, have increased the number of patients receiving and living with kidney transplants who are at risk for the long-term complications of transplantation. Cancer has become a major cause of death following kidney transplantation, increasing the need to better understand the risk of post-transplant malignancy and to adapt patient management to minimize that risk. Areas covered: This paper reviews the scope of the problem of post-transplant malignancy, its pathogenesis, and strategies for prevention, with attention to the impact of various immunosuppressive strategies. A Medline search was conducted, reviewing English-language publications from 1948 to February 2011. Expert opinion: Post-transplant malignancy, one of the most common causes of death following transplantation, is linked to both modifiable and non-modifiable risk factors. The current armamentarium of pharmacotherapy and the possibilities for immunologic monitoring in the future hold the potential for tailoring post-transplant care to minimize the risk of post-transplant malignancy without sacrificing graft survival to optimize outcomes following transplantation.