Four experts will discuss Malignancy in Transplant Patients during a Tuesday morning Next Frontier plenary session. James McKiernan, MD, will moderate the 20-minute Complex Cases session, which begins at 8:50 a.m. in Ballroom East in the Boston Convention and Exhibition Center.
“This is not a wildly common scenario, but it is becoming more common with the increasing use of organ transplant, and the immunosuppression involved causing patients to develop an increased risk for cancer,” said Dr. McKiernan, Chair of the Department of Urology and Director of Urologic Oncology at Columbia University Medical Center and New York Presbyterian Hospital.
The panel will address several transplant issues, including how best to manage bladder carcinoma in situ. In patients with intact immune systems, this is generally managed with bacillus Calmette-Guérin (BCG).
“In transplant patients, however, the immune suppression therapy they must receive makes this a potentially dangerous option,” Dr. McKiernan said. “Some recent case reports have shown that with careful monitoring, BCG can still be used in transplant patients, but it generally will not work as well as in patients with intact immune systems. This can be particularly challenging because there are few secondary treatment options for this malignancy, and they generally have steep drops in efficacy compared with BCG.”
In addition to treating cancer patients after transplant, urologists may be asked to evaluate patients for cancer risk prior to a transplant. This is becoming more common as transplant rates increase.
“According to the United Network for Organ Sharing, the U.S. has seen a 20 percent increase in organ transplants over the past five years,” Dr. McKiernan said. “It’s going to be more likely that a urologist will walk into his or her clinic and see a patient who has an organ transplant.”
One of the case presentations during the session involves exophytic renal cell carcinoma in a transplanted kidney.
“In general, we try very hard to take out that tumor and leave in the kidney,” Dr. McKiernan said. “Partial nephrectomy would be the ideal surgical option, but this can be complicated because you’re operating on a kidney that was transplanted into a patient’s body, making it a technically more difficult surgery.”
Treating transplant patients in whom cancer develops may require an adjustment to immunosuppressive therapy, and the time since transplant will play a large role in determining the feasibility of such an action.
“If the malignancy develops soon after the transplant, it may prove dangerous to reduce immunosuppression. But if it has been several years, this often means reductions are possible without substantially increasing risk,” Dr. McKiernan said. “In certain cases this could help patients receive chemotherapy, or make recovery from surgery faster and smoother.”
Dr. McKiernan will be joined on the panel by Patrick Luke, MD, professor of Surgery and Co-director of the Multi-Organ Transplant Program at London Health Sciences Centre in Ontario, Canada; Dicken S. C. Ko, MD, FRCSC, FACS, associate professor of Surgery at Harvard Medical School and Director of Regional Urology for Massachusetts General Hospital; and Ronald Moore, MD, PhD, FRCSC, FACS, from the Division of Urology at the University of Alberta in Canada.