Title:De Novo Malignancies After Organ Transplantation: Focus on Viral Infections
Volume: 13
Issue: 7
Author(s): P. Piselli, G. Busnach, L. Fratino, F. Citterio, G. M. Ettorre, P. De Paoli, D. Serraino and The Immunosuppression and Cancer Study Group
Affiliation:
Keywords:
Cancer risk, iatrogenic immunosuppression, Kaposi sarcoma, non-Hodgkin lymphoma, solid organ
transplantation, viral infection.
Abstract: Organ transplantation is an increasingly used medical procedure for treating otherwise fatal endstage
organ diseases with 107,000 transplants performed worldwide in 2010. Newly developed anti-rejection
drugs greatly helped to prolong long-term survival of both the individual and the transplanted organ, and they
facilitate the diffusion of organ transplantation. Presently, 5-year patient survival rates are around 90% after
kidney transplant and 70% after liver transplant. However, the prolonged chronic use of immunosuppressive
drugs is well known to increase the risks of opportunistic diseases, particularly infections and virus-related
malignancies. Although transplant recipients experience a nearly 2-fold elevated risk for all types of de-novo
cancers, persistent infections with oncogenic viruses – such as Kaposi sarcoma herpes virus, high-risk human
papillomaviruses, and Epstein-Barr virus – are associated with up to 100-fold increased cancer risks. This
review, focusing on kidney and liver transplants, highlights updated evidences linking iatrogenic
immunosuppression, persistent infections with oncogenic viruses and cancer risk. The implicit capacity of
oncogenic viruses to immortalise infected cells by disrupting the cell-cycle control can lead, in a setting of
induced lowered immune surveillance, to tumorigenesis and this ability is thought to closely correlate with
cumulative exposure to immunosuppressive drugs. Mechanisms underlying the relationship between viral
infections, immunosuppressive drugs and the risk of skin cancers, post-transplant lymphoproliferative
disorders, Kaposi sarcoma, cervical and other ano-genital cancers are reviewed in details.
