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Moldvai D, Sztankovics D, Dankó T, Vetlényi E, Petővári G, Márk Á, Patonai A, Végső G, Piros L, Hosszú Á, Pápay J, Krencz I, Sebestyén A. Tumorigenic role of tacrolimus through mTORC1/C2 activation in post-transplant renal cell carcinomas. Br J Cancer 2024; 130:1119-1130. [PMID: 38341510 PMCID: PMC10991560 DOI: 10.1038/s41416-024-02597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Kidney transplant recipients (KTRs) face an increased risk of renal cell carcinoma (RCC), in which the immunosuppressive regimen plays an important role. This study aimed to identify intracellular signalling alterations associated with post-transplant (post-tx) tumour formation. METHODS Expression of mTOR-related proteins were analysed in kidneys obtained from end-stage renal disease (ESRD) patients and RCCs developed in KTRs or non-transplant patients. The effects of tacrolimus (TAC) and rapamycin (RAPA) on mTOR activity, proliferation, and tumour growth were investigated through different in vitro and in vivo experiments. RESULTS Elevated mTORC1/C2 activity was observed in post-tx RCCs and in kidneys of TAC-treated ESRD patients. In vitro experiments demonstrated that TAC increases mTOR activity in a normal tubular epithelial cell line and in the investigated RCC cell lines, moreover, promotes the proliferation of some RCC cell line. In vivo, TAC elevated mTORC1/C2 activity in ischaemic kidneys of mice and enhanced tumour growth in xenograft model. CONCLUSIONS We observed significantly increased mTOR activity in ischaemic kidneys and post-tx RCCs, which highlights involvement of mTOR pathway both in the healing or fibrotic processes of kidney and in tumorigenesis. TAC-treatment further augmented the already elevated mTOR activity of injured kidney, potentially contributing to tumorigenesis during immunosuppression.
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Affiliation(s)
- Dorottya Moldvai
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Dániel Sztankovics
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Titanilla Dankó
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Enikő Vetlényi
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Gábor Petővári
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Ágnes Márk
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Attila Patonai
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői út 78., H-1082, Budapest, Hungary
| | - Gyula Végső
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői út 78., H-1082, Budapest, Hungary
| | - László Piros
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői út 78., H-1082, Budapest, Hungary
| | - Ádám Hosszú
- Department of Paediatrics (Bókay street Unit), Semmelweis University, Üllői út. 26, H-1085, Budapest, Hungary
- MTA-SE Lendulet Diabetes Research Group, Bókay János utca 53-54., H-1083, Budapest, Hungary
| | - Judit Pápay
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Ildikó Krencz
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary
| | - Anna Sebestyén
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26., H-1085, Budapest, Hungary.
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Putz J, Kestel V, Herout R, Borkowetz A, Leike S, Thomas C, Baunacke M. [Urogenital tumors following kidney transplantation-monocentric analysis of incidences and overview of urological preventive measures]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:341-350. [PMID: 38512472 PMCID: PMC10990984 DOI: 10.1007/s00120-024-02317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Urogenital tumors are among the most common solid malignancies after kidney transplantation (TX). OBJECTIVE We analyzed the incidence and mortality of urogenital tumors after kidney TX in our own patient population as well as answered the question of recommended follow-up necessity and frequency in this cohort. MATERIALS AND METHODS Retrospective monocentric data collection of tumor diseases and the most common urogenital tumors after kidney TX at the Transplant Center Dresden between 2010 and 2020 was done. From this, we derived recommendations for a useful follow-up concept. RESULTS A total of 13% (93/710) of kidney TX patients developed a neoplasm. Older patients (60.1 ± 10.6 vs. 53.8 ± 12.5; p < 0.001), with higher Charlson scores (≥ 4: 68% vs. 46%; p < 0.001) and a previous tumor history (18% vs. 8%; p < 0.001) were more likely to develop a neoplasm after transplantation. In the multivariate analysis, previous tumor history was found to be an independent predictor of tumor development after renal transplantation (OR 2.2; 95%-KI [1.2-4.1]; p = 0.01). Urogenital tumors accounted for 30% (28/93) of all malignancies. Renal cell carcinoma of the native kidney was the most common (n = 12) neoplasm, followed by prostate cancer (n = 9). CONCLUSION Most solid malignancies after kidney TX arise from the urinary tract. Due to their frequency, there is an urgent need for specialized urological therapy and long-term follow-up care. Even before listing for TX, risk factors can be recognized and individual concepts for follow-up care can be developed.
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Affiliation(s)
- J Putz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - V Kestel
- Medizinische Fakultät, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Deutschland
| | - R Herout
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - A Borkowetz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S Leike
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - C Thomas
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Baunacke
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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De-novo malignancies after kidney transplantation: A long-term observational study. PLoS One 2020; 15:e0242805. [PMID: 33253202 PMCID: PMC7703884 DOI: 10.1371/journal.pone.0242805] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. Methods This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies. Results 1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation. Conclusion De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.
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Farkas ÁZ, Török S, Kovács JB, Piros L, Végső G, Kiss G, Korda D, Bibok A, Hartmann E, Deák ÁP, Doros A. Diagnosis and Management of a De Novo Urothelial Carcinoma in a Kidney Allograft: A Case Report. Transplant Proc 2019; 51:1281-1285. [PMID: 31101214 DOI: 10.1016/j.transproceed.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Following renal transplantation, the incidence of malignancies is 3-5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. CASE REPORT A 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. CONCLUSIONS Painless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.
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Affiliation(s)
- Ádám Z Farkas
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
| | - Szilárd Török
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - János Balázs Kovács
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - László Piros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Gyula Végső
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Gergely Kiss
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Dávid Korda
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - András Bibok
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Erika Hartmann
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Ákos P Deák
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Attila Doros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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Colorectal Cancer Characteristics and Outcomes after Solid Organ Transplantation. JOURNAL OF ONCOLOGY 2019; 2019:5796108. [PMID: 30941176 PMCID: PMC6421000 DOI: 10.1155/2019/5796108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/09/2018] [Accepted: 02/06/2019] [Indexed: 12/21/2022]
Abstract
Background Individuals after solid organ transplant may develop secondary malignancies. In our clinical practice, we noted an increasing number of individuals who developed colorectal cancers after solid organ transplantation. The primary aim of this study was to describe the characteristics and outcomes of the patients who developed colorectal cancer after solid organ transplant. Materials and Methods Data was gathered and merged from several registries at Mayo Clinic to identify all patients who received a diagnosis of colon or rectal cancer and solid organ transplant. Continuous variables were summarized as mean (standard deviation) and median (range), while categorical variables were reported as frequency (percentage). Time to colorectal cancer after transplant and overall survival after cancer diagnosis were estimated using Kaplan-Meier method. Results Initially, 115 colorectal cancer patients who also had a transplant were identified. The diagnosis of colorectal cancer was noted after solid organ transplant in 63 patients. The mean age at transplant was 57 years. Majority had received a kidney transplant (44.4%) followed by liver (36.5%). The median time to develop colorectal cancer was 59.3 months (range: 4.4-251.4 months). 15 (24.6%) were stage 4 at diagnosis and 13 (21.3%) had stage 3 colorectal cancer. Median overall survival was 30.8 months; 5-, 10- and 15-year survival were noted to be 42.5%, 17.9%, and 7.5%, respectively. None of the stage 4 patients were alive at 5 years; 5-year survival rate for stage 1, 2, and 3 patients was 77%, 50%, and 42%, respectively. Conclusions Our study reports on one of the largest cohorts of patients of colorectal cancer that developed the cancer after solid organ transplant. Survival is extremely poor for advanced cases. However, long-term survivors are noted who developed the cancer at a relatively early stage. Colorectal screening recommendations may need to be revised for patients after solid organ transplant.
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Abstract
Proper pre- and post-transplant diagnostic imaging work-up is fundamental in ensuring a successful outcome for renal transplantation. Despite exposure to ionizing radiation, CT has high spatial resolution and is a widely available and fast imaging technique. CT is performed routinely to delineate the anatomy of the kidney, relevant vasculature, and urinary collecting system in the living donor, to assess the iliac vessels in potential recipients prior to surgery, and to assess early and late-term post-transplant complications. The purpose of this article is to outline the optimal CT protocol and the main reportable findings for both the donor and the recipient diagnostic imaging work-up as well as to point out the main issues regarding ionizing radiation exposure and contrast medium injection in these subjects.
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Rutkowski J, Cyman M, Ślebioda T, Bemben K, Rutkowska A, Gruchała M, Kmieć Z, Pliszka A, Zaucha R. Evaluation of peripheral blood T lymphocyte surface activation markers and transcription factors in patients with early stage non-small cell lung cancer. Cell Immunol 2017; 322:26-33. [DOI: 10.1016/j.cellimm.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
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