De novo malignancy development following kidney transplantation: Managing risks and outcomes in clinical practice.

Abstract

Objective: De novo malignancy is a significant complication following kidney transplantation, attributed to prolonged immunosuppression. This study evaluates the incidence, risk factors, and clinical outcomes of de novo malignancies in kidney transplant recipients.

Material and methods: A retrospective cohort analysis was conducted on 1200 kidney transplant recipients between 2016 and 2023. Patients were categorized based on the presence or absence of de novo malignancies. Statistical analyses were performed to identify risk factors, including age, sex, comorbidities, and immunosuppressive regimens. Patient and graft survival were assessed using Kaplan-Meier analysis and the log-rank test.

Results: Among the study population, 43 patients (3.6%) developed de novo malignancies. The most frequent malignancy types were non-melanoma skin cancers (27.9%) and post-transplant lymphoproliferative disorders (18.6%). Patients with malignancies exhibited a lower three-year survival rate (83.7%) compared to those without malignancies (91.4%), though the difference was not statistically significant (p=0.067). Graft survival at three years was slightly lower in the malignancy group (84.0% vs. 88.7%, p=0.146). Older recipient age was identified as a significant risk factor (hazard ratio=1.03 per year, p=0.025).

Conclusion: De novo malignancy remains a concern in kidney transplant recipients, particularly among older patients. Regular screening protocols, lifestyle interventions, and individualized immunosuppressive regimens are essential to mitigate risk and improve outcomes.