Malignancies in renal transplant patients: 15 years experience in Thailand
ABSTRACT The increased incidence of malignancies post-renal transplantation is well established. We performed a retrospective review of the 270 renal transplant patients from May 1, 1992 to April 30, 2007, including 18 cases (6.7%) of malignancy. The most common cancer in the study was transitional cell carcinoma of the urinary tract (7/18). The second most common cancer was hepatocellular carcinoma (3/18). In contrast to reports from Caucasian countries, we found only 2/18 patients had posttransplantation lymphoproliferative disease and no report of skin cancer. Among the 18 patients with malignancy, 11 died (mortality rate = 61%). We encourage a more extensive study of malignancy post-renal transplantation at multiple centers with a tumor registry in Thailand.
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ABSTRACT: We present a female patient with end-stage renal disease who was referred to the emergency department with sudden, excruciating pain over the right lower abdomen and flank. Radiologic evaluation following admission revealed a mass, solid in nature, located at the upper pole of the transplanted kidney. The patient was treated with empiric antibiotics and analgesics, and her symptoms subsided over the course of the week. Based on the clinical course and radiological findings, a self-limiting, spontaneous haemorrhage was thought to be the cause of the patient's symptoms. Nevertheless, background malignancy could not be ruled out. Therefore, an interval, elective graft nephrectomy was scheduled. Pathology confirmed the diagnosis of renal clear cell carcinoma.NDT Plus 11/2009; 2(6):476-478. DOI:10.1093/ndtplus/sfp106
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ABSTRACT: To clarify the demographic data, outcomes and complications of renal transplantation in children at Srinagarind (university) Hospital. The authors reviewed the medical records of children with end-stage renal disease (ESRD) who received renal transplantation at Srinagarind Hospital, Khon Kaen, between August 2001 and July 2008. Eight male and seven female patients were identified Their mean age was 12.8 +/- 3.2 years (range, 5.0-17.6). The major cause of ESRD was a congenital anomaly of the kidneys (53%). All of the children received cadaveric transplantations and none received induction therapy. Triple immunosuppressive drugs comprising cyclosporine, prednisolone and mycophenolate mofetil were administered to 12 patients. Tacrolimus, instead of cyclosporine, was given to three patients who had received a renal transplant since January 2008. The median follow-up time was 15 months (3 to 82 months). The most frequent complication was urinary tract infection (40%). Acute graft loss was found in one patient (6.7%) due to graft infarction. Other complications included herpes viral infection, chronic rejection, acute rejection, severe gingival hyperplasia, myopathy, lymphocele and transitional cell carcinoma of the bladder. Two patients returned to dialysis due to graft infarction and chronic rejection, respectively. The mean serum creatinine at the last follow-up of the remaining cases was 1.2 +/- 0.5 mg/dL (range, 0.6-2.3). All of the patients survived. The 1- and 5-year graft survival rates were 93.3% and 86.7%, respectively. The present study demonstrates the potential for successful outcomes of pediatric renal transplantation in this resource-limited area.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 12/2009; 92(12):1635-9.
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ABSTRACT: Skin cancers are the most common malignancies in solid organ transplant recipients (SOTR). A case-observational, retrospective study was performed to determine the efficacy of low-dose capecitabine in the secondary prevention of skin cancers in SOTRs treated at a single institution. SOTRs with recurrent squamous cell carcinoma (SCC) and/or basal cell carcinoma (BCC) were given low-dose capecitabine 1 g/m(2) daily, days 1-14 of a 21-d treatment cycle. Skin surveillance was performed by dermatologists every 1-3 months. Cumulative incidence rates of SCC, BCC, and actinic keratosis (AK) before and after treatment were scored and statistically compared for each patient using a non-parametric Wilcoxon signed rank test. Fifteen patients (13 men and two women) with a median age of 57 yr (range 40-73) were treated. Incidence rates as measured by mean number of events per month declined by 0.33 for SCC, 0.04 for BCC, and 2.45 for AK (p < 0.05). The most common grade 3 and 4 toxicities included fatigue (40.0%), hand-foot syndrome (20.0%), and diarrhea (20.0%). The discontinuation rate at one yr was approximately 33.3%. We conclude that oral capecitabine significantly decreases the incidence rates of recurrent SCC, BCC, and AK in SOTRs and is associated with manageable toxicity.Clinical Transplantation 11/2010; 25(4):541-8. DOI:10.1111/j.1399-0012.2010.01348.x · 1.49 Impact Factor