Racial and ethnic variations in incidence and pattern of malignancies after kidney transplantation
Malignancies are a well-recognized complication of renal transplantation. Although the problem is well studied in developed countries, less is known about it in developing countries. Although geographic and ethnic variations have been alluded to in several reports, to our knowledge the subject has not been investigated formally. From April 1976 through March 1999, 41 (7.6%) patients were diagnosed with cancer among a heterogeneous population of renal allograft recipients treated at our institution in Cape Town, South Africa. The incidence of malignancies was comparable in white and nonwhite patients. However, squamous cell cancer and basal cell cancer of the skin (in that order) were the most common cancers in white patients, in whom they occurred exclusively. On the other hand, Kaposi sarcoma was the most common cancer in nonwhite renal allograft recipients, in whom it accounted for almost 80% of all cancers. Review of the world literature suggests that posttransplant cancers are less common in developing countries; Kaposi sarcoma is the most common lesion, with few exceptions. Malignant lymphomas are also more common in developing countries. The impact of different immunosuppressive regimens is controversial. In general, cyclosporine is not associated with a significant increase in the incidence of cancer after renal transplantation, although the time to the first cancer may be reduced. In our experience, the pattern of posttransplant cancers in white and nonwhite patients living in the same geographic region epitomizes the world experience of the disease and suggests that genetic factors, rather than geography, are the more important determinants of cancer development after renal transplantation.