Organ Transplant Recipients at Greater Risk for a Variety of Cancers

Nov. 2, 2011— -- Three. That's the number of kidney transplants Irene Schneider has received so far in her lifetime. Each new kidney has allowed her to skirt a potential lifetime of dialysis, or even death.

When doctors found a "massive" tumor plaguing Schneider's body shortly after her birth, it had already caused so much kidney damage that they gave her 15 years to live.

"I was a rickety kid," she said. "My parents always made an effort to reinforce my self-image through an organ that worked — my brain."

Now, at 61, Irene Schneider, an executive editor at Conde Nast Traveler, has outlived her doctors' predictions threefold, with a total of 35 surgeries under her belt.

When she was 34, Schneider received her first kidney transplant from her brother. Ten years later, that kidney started failing and Schneider's sister donated hers, which functioned for 15 years. When Schneider needed a third kidney, more than 20 people offered to be the next donor. Two years ago, she received her newest kidney from her brother-in-law. While other family members were a match, Schneider's body had begun developing antibodies to her family's own gene pool.

The new kidneys have kept her alive, but they also put her at greater risk of other fatal diseases. Soon into adulthood, doctors warned Schneider that a weakened immune system, brought on by the transplants, results in an elevated risk of certain kinds of cancer. Doctors said she was at particular risk for uterine, skin and breast cancers.

"I thought, 'Thank you for telling me that,'" said Schneider. "I've always wanted clarity, even if it's bad news. I like things to be as clear as possible."

While organ transplants are a lifesaving procedure, most transplant recipients are far from finished with hospital visits once the new organ is successfully accepted into the body.

As a young woman, Schneider received several biopsies — all negative — before doctors called her in for a follow-up biopsy in 2003.

"Finally, it happened," she said. "I said to them, 'OK, now let's deal with it."

Oncologists removed the cancer from her breast and she has remained in remission for six years. A hysterectomy spared Schneider the risk of uterine cancer, she said.

Schneider is certainly not the only patient to receive a cancer diagnosis after a transplant. And now, a new study, published Tuesday in the Journal of the American Medical Association, confirmed the risks that Schneider, and so many other patients are warned about. Researchers from the National Cancer Institute found that patients like Schneider are at twice as much risk of getting cancer than the general population.

"Transplants are truly one of the miracles of modern medicine," said Dr. Eric Engels, a senior investigator of the National Cancer Institute and lead author of the study. "But a weakened immune system certainly plays a role in organ transplant patients being at risk of cancer."

The study examined more than 175,000 organ transplants performed in the United States, which made up nearly 40 percent of all transplants procedures between 1987 and 2008. Recipients were at twice as much risk of the general population for developing cancer.

The most common cancer among the data analyzed was non-Hodgkin's lymphoma-- a weakened immune system is a known risk factor for the cancer. Engels said many cancers were also detected in the original damaged organ, so often, those who received a lung transplant were then diagnosed with lung cancer, kidney transplant with kidney cancer, which could, again, result from the organ's weakened state.

And for reasons that Engels said were not quite clear, patients were also at greater risk of developing skin cancer.

Doctors have reconstructed Schneider's nose twice because of skin cancer removed from the area.

It is important to maintain recommended follow-ups to detect and treat post-transplant cancers early in their course, preferably before patients become symptomatic, said Dr. Fredric Gordon, medical director of liver transplantation at Lahey Clinic Medical Center in Burlington, Mass.

"To that end, patients should have annual dermatologic exams and Pap smears (if appropriate), and PSAs, colonoscopy, digital rectal examination, etc., as recommended," Gordon said. "Appropriate skin care and sun protection is essential. Avoidance of known carcinogens such as cigarette smoke is also essential."

Of course, despite the potential cancer diagnosis, experts warn that the study results should not deter patients from receiving transplants.

"Yes, the risk of cancer is higher, but the alternative to transplant is usually death," said Dr. Jeffrey Punch, chief of the section of transplantation in the department of surgery at University of Michigan. "In the case of kidney transplantation where the alternative is dialysis, it still doesn't make sense to dwell on the cancer risk because the most common cause of death in patients with kidney disease is ... heart attacks and strokes."

The risk of these diseases is many times higher in dialysis patients compared to transplant patients, which is why life expectancy is roughly double in kidney transplant patients compared to patients waiting on dialysis despite the risk of more cancer, Punch said.

As for Schneider, she said she leads as healthy a life as possible — she eats well, walks a mile and a half to and from work every day, and drinks copious amounts of water. But really, Schneider said she doesn't worry about the cancer prognosis as much as she worries about kidney failure. And even then, all she can do is take the diagnoses and medical prodding as it comes.

"I never really considered the 'why me?'" said Schneider. "Why not me? I guess I adjusted at an early age to the fact that something is going to get you. I've never seen myself as a victim. I see myself as a survivor."