COMMENTARY

Screening and Early Detection: Cancer in the Kidney Transplant Recipient

Bryce A. Kiberd, MD

Disclosures

December 14, 2005

In This Article

Summary

Although the goals may be essentially the same, the rationale for cancer screening in a patient being considered for kidney transplantation is different from the rationale in a kidney transplant recipient. The overall yield of cancer detection and survival benefit has not been sufficiently evaluated to allow for anything more than expert opinion regarding recommendations for cancer screening. My expert opinion is that screening patients prior to listing for kidney transplantation is worthwhile and highly recommended. My recommendations for screening are listed in Table 3 . For solid cancers such as breast and colorectal cancer, for which there is little or no increased incidence after transplantation, screening should be done only in patients with a reasonable life expectancy and in the absence of a failing graft. On the other hand, screening for cervical cancer in female, age-appropriate patients is recommended, given the high risk and aggressive nature of this disease after transplantation. Screening for skin cancers, although not recommended in the general population, is an important area of concern for kidney transplant recipients, and recommendations are evolving. In the interim, each center should implement a strategy that best fits with its resources and expertise. Screening for EBV-related lymphomas with viral titers for EBV in high-risk patients is an area of active research. Until these strategies have been fully evaluated, maintaining a high index of suspicion for PTLD at each patient encounter seems prudent.

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