How Common is Cancer in Organ Transplant Recipients?

As an organ transplant recipient, you already “know” several things:

• You know what the anxiety and stress of end-stage organ disease feels like
• You know that your life has been improved after receiving your transplant
• You know that by taking care of your transplant, you can reduce the risk of rejection of the organ

Did you also know that the important immunosuppressants (anti-rejection medications) you take to prevent your body from rejecting your transplanted kidney, heart, lung, or liver may increase your risk of developing certain types of
cancer?¹

While the risk of dying from cancer is low, you need to be proactive and get screened for various types of cancer—most notably skin cancer.

“It’s important to know about risks that we have an opportunity to reduce and do something about,” says David J. Reich, MD, FACS, Director of the Tower Health Transplant Institute. “Post-transplant cancer is definitely that kind of a risk.”

Dr. Reich, who is also Professor and Chief of Multiorgan Transplantation and Hepatobiliary Surgery at Drexel University College of Medicine and Tower Health System, says as a transplant recipient, you can live a long, healthy life. He also says that you need to ensure that you take the steps necessary to prevent cancer—or to catch it early.

Anti-rejection Meds Help Maintain the Health of Your Transplanted Organ

Anti-rejection medications are critical for protecting your transplanted organ from your body’s immune system.²

Simply put—anti-rejection medications help you maintain the health of your transplanted kidney, heart, lung, or liver.³

“The risks of stopping your anti-rejection medications are very serious” says Dr. Reich, who confirms that anti-rejection medications can also make your immune system less able to detect and destroy cancer cells—or fight off infections that cause cancer.⁴

Despite the risk of cancer associated with taking anti-rejection medications, Dr. Reich emphasizes that stopping your anti-rejection medications would not be a good strategy to undertake if you are concerned about developing cancer after your transplant.

If you get an organ transplant, Dr. Reich says it is common practice for your transplant team to discuss with you the risks around certain cancer types and what you can do to reduce your risk.  Ideally, he adds, these discussions happen before you receive your transplant.

A High Incidence of Non-Melanoma Skin Cancer

The spectrum of cancer risk in transplant recipients differs on the cancer type. Furthermore, this increased cancer risk is not evenly spread over all types of cancer. For example:

• Some cancer incidences are increased (melanoma, non-melanoma skin cancer, lung, colon, liver, lymphoma)
• Other cancer incidences are not increased (breast, prostate, ovarian, brain, and cervical)⁵

Dr. Reich says some post-transplant cancers are related to viruses that immunocompromised people (i.e., organ transplant recipients) sometimes have. For example, he points out that:

• Hepatitis C can be a risk factor for transplant recipients having liver cancer
• Human papillomavirus (HPV) is a risk factor for cervical cancer
• Epstein-Barr virus (EBV) is a risk factor for a specific type of lymphoma

The most common type of cancer that transplant recipients get, though, is skin cancer. 

Organ transplant recipients are at a 100-fold higher risk for developing skin cancer compared to the general population—with heart and lung transplant recipients developing skin cancer more frequently than liver or kidney transplant recipients. ⁶

In fact, more than 50% of solid organ transplant recipients are ultimately diagnosed with at least one skin cancer.⁷

Why Skin Cancer?

The reason for this is because anti-rejection medications can make your skin more sensitive to sunlight, which may lead to skin cancers.⁸

Non-melanoma skin cancer is the most common malignancy (cancerous tumor) in Caucasian, adult, solid organ transplant recipients.⁹

“By 10 years post-transplant, most transplant recipients have had some form of skin cancer,” says Dr. Reich. “Fortunately, that is usually treated and cured.”

These cancers tend to present on the parts of the body where we have the most sun exposure. According to Dr. Reich, having these skin cancers treated can sometimes be disfiguring, but they are typically not lethal— just something that needs to be managed.

You can reduce your risk by taking preventive action including wearing sunscreen and covering up when in direct sun light.

The other cancers that occur at somewhat higher rates in transplant recipients are:

• Non-Hodgkin lymphoma (14% of all cancers in transplant recipients)
• Lung cancer (13% of all cancers in transplant recipients)
• Liver cancer (9% of all cancers in transplant recipients)
• Kidney cancer (7% of all cancers in transplant recipients)¹⁰

While these statistics are sobering, they occur in a small percentage of organ transplant patients.

“Organ transplantation is life-saving and provides a high quality of life and long-term survival for the vast majority of recipients who—without the organ transplant—might succumb to their end-stage organ disease,” says Dr. Reich.

The Importance of Cancer Screening in Transplant Recipients

Dr. Reich adds that you must care for yourself after your transplant, which includes routinely screening for cancer.

Taking it one step further, Dr. Reich suggests working closely with your nurses, PharmDs, physicians, and surgeons at the center.

In addition to routinely meeting with a dermatologist who understands the higher risks of transplant recipients, Dr. Reich says you should also stay on schedule for:

• Colonoscopies
• Mammograms (for women)
• PSA labs and prostate exams (for men)
• Gynecologic examinations (for women)

New Website Aims to Educate and Encourage Cancer Screening in the Transplant Community

Transplant Recipients International Organization (TRIO) has launched a new patient website that aims to educate people about post-transplant cancer.

Jim Gleason, president of TRIO, says the framework of the website (https://www.triowebptc.org/) is quite simple and focuses on four Ls:

• Learn about the risks
• Look for the symptoms
• Live a proactive life
• Link to more resources

TRIO says that there is nothing you can do about your increased risk of cancer associated with anti-rejection use, but there are healthy lifestyle choices to consider including:

• Following your transplant team’s advice and recommended precautions and healthcare screenings
• Following your care team’s advice when it comes to sun exposure
• Seeing a dermatologist regularly who specializes in treating transplant patients
• Quitting smoking (if you smoke)
• Eating a healthy, balanced diet
• Losing weight (if you are overweight)
• Staying active¹¹

Dr. Reich says TRIO’s post-cancer website is one of the best resources for a transplant recipient that he has encountered.

“I think that familiarizing yourself with the website really empowers you as a transplant recipient to be knowledgeable, to advocate for yourself, and to live longer,” says Dr. Reich.

The TRIO/ CareDx webinar “Cancer as a Transplant Recipient: Understand Your Risks and Learn What to Do,” featuring Dr. Reich, is now available to view, click here.

Always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition. The information is not intended or implied to be a substitute for professional medical advice from your healthcare provider.

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