Clinical management of cancer after kidney transplantation

Advances in immunosuppressive therapy have markedly improved short-term graft survival post-kidney transplantation (KT); however, these advances have also profoundly altered long-term disease patterns in transplant recipients. Cancer remains a major barrier limiting improvements in long-term survival. Kidney transplant recipients are at increased risk of malignancy owing to impaired graft function and immunosuppressive medications. To improve cancer-related outcomes, comprehensive strategies encompassing prevention, early detection through screening, and appropriate treatment are required. Primary prevention includes the appropriate selection and maintenance of immunosuppressive medications, careful consideration of KT indications for recipients and donors with previously treated cancers, and vaccination. Secondary prevention requires effective, risk-adapted cancer screening in high-risk kidney transplant recipients. Following a cancer diagnosis, management includes localized resection and systemic therapy for primary, recurrent, or refractory disease. Systemic therapy includes chemotherapy and immunotherapy, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, which may affect graft function and cause treatment-specific adverse effects. Additionally, immunosuppressive medications often require modification to minimize the risk of graft rejection while maintaining a low likelihood of recurrence. In this review, we summarize current strategies for cancer prevention, screening, and treatment following KT.