In 2021, more than 24,600 Americans received a kidney transplant. About 1 in 3 people get a kidney from a living donor, while the rest get a kidney from a deceased organ donor. Kidney transplants can be lifesavers for people experiencing kidney failure, kidney cancer, or chronic kidney disease (CKD). 

But transplants also have risks. Most people are aware of the potential for organ rejection. Organ recipients take immunosuppressants to keep their bodies from rejecting the donor organ. These medications, as well as other factors, can increase your risk of developing renal cell carcinoma (RCC) and other cancers.

From the community: “In Nov 2009 my husband received a kidney transplant... In April 2016 (doctors) discovered invasive bladder cancer. His only option was to remove bladder. (They) removed his bladder, prostrate, both old kidneys and cut his intestine to make stoma for bag. It was a very long surgery but he made it through and is on the mend. His transplanted kidney made it through and it is cancer free...” – Inspire member

What is renal cell carcinoma?

Renal cell carcinoma (RCC) is the most common type of kidney cancer. Of the approximately 79,000 Americans diagnosed with kidney cancer each year, 9 out of 10 have RCC. This cancer forms in the lining of renal tubules. These small tubes in your kidneys filter waste from your blood. The waste leaves your body when you pee.

How does a kidney transplant increase cancer risk?

Experts are still trying to determine why getting an organ transplant increases your risk of cancer. One study found that recipients of any type of organ transplant (not just kidney) were twice as likely to develop cancer as people who don’t get organ transplants. In the study, 7% of organ transplant recipients developed kidney cancer.

Potential reasons for this increased kidney cancer risk include:

• immunosuppressants

• dialysis

• kidney cancer in the donor kidney

From the community: “…I received a kidney from my sister in 1981, due to cytoxan for the transplant, developed Bladder Cancer in 1995. Neo-bladder surgery was completed in 2009, in fact I have a CT scan in April and my third year check-up has been scheduled for May. If I can, I will answer any questions you have…” – Inspire member

Immunosuppressants

Immunosuppressants are medications that suppress, or weaken, your immune system. When you receive a donor kidney, immunosuppressants stop your immune system from treating the new organ as a threat and attacking it. Without these drugs, your body can reject the donor organ. If this happens, you’ll need dialysis temporarily until a new donor kidney is available, or you may stay on dialysis long-term. 

Studies suggest that the longer you take immunosuppressants, the greater the risk of cancer. That’s because the drugs can weaken the cancer-fighting abilities of important immune cells like T cells. The weakened T cells aren’t able to stop cancer cells from multiplying and spreading.

Dialysis

More than 9 in 10 cases of renal cell carcinoma that occur after a kidney transplant develop in your own kidneys (what doctors call the native kidneys) and not the donor organ. The cancer may form in a kidney that’s still functioning or a nonfunctioning kidney left in place during the transplant procedure. 

Kidney cancer is more likely to affect a native kidney that has a lot of kidney cysts due to polycystic kidney disease (PKD). People with PKD, chronic kidney disease, or kidney failure often need dialysis. Studies have shown a five-fold increase in kidney cancer among people who use long-term dialysis. 

Kidney cancer in the donor kidney

It is possible, and safe, to receive a donor kidney from someone who has undergone certain kidney cancer treatments. For instance, a person who had a partial nephrectomy to remove a cancerous tumor that’s smaller than 1.5 inches (4 centimeters) may still donate the kidney. The chance of cancer recurring in the donor kidney is low. Still, your doctor will monitor your new kidney for signs of kidney cancer. 

Early transmission of kidney cancer from a donor organ (within the first six weeks of transplantation) tends to respond better to treatments than cancer that develops later. More than 8 in 10 people who develop kidney cancer from a donor kidney are still alive five years later. This is just slightly less than the 9 in 10 cancer-free kidney transplant recipients who are still alive five years later.

From the community: “My brother had a successful kidney transplant 2 yrs ago, but recently diagnose with lung adenocarcinoma. Pulmonologist believe it’s caught early based on ct w contrast. Pulmonologist recommended surgery and made referral to surgery w/o oncology referral. Surgeon decided on either wedge resection or lobe removal.. To be determine in the OR. In the meantime, anti rejection meds has been reduced…Wonder if this would destroy transplanted kidney...” – Inspire member

How do doctors treat kidney cancer after a kidney transplant?

The risk of organ rejection poses special challenges to the treatment of kidney cancer after a kidney transplant. Your doctor will choose a treatment based on the kidney cancer stage. Stage 1 and stage 2 kidney cancers are localized to the organ, which means the cancer hasn’t spread. You may undergo surgery (a nephrectomy) to remove just the cancerous tumor.

Metastatic kidney cancer is more difficult to treat. Kidney cancer can spread (metastasize) outside of the kidney to other parts of your body, like your lungs or bones. In one study, 1 in 3 transplant recipients with metastatic kidney cancer experienced a partial or complete cancer remission with the use of immune checkpoint inhibitors. However, there was a 40% organ rejection rate. Because of the unique nature of being a kidney transplant recipient with kidney cancer, your doctor may recommend trying new therapies under evaluation in clinical trials. 

Sources

• How common is kidney cancer? American Cancer Society. May 2020.

• Key statistics about kidney cancer. American Cancer Society. January 2022.

• Sprangers B, et al. Risk factors associated with post-kidney transplant malignancies: An article from the Cancer-Kidney International Network. Clinical Kidney Journal. June 2018.

• Detailed description of data. Health Resources and Services Administration (HRSA). February 2022.

• Kidney transplant. Mayo Clinic. January 2022.

• Organ transplants and cancer risk. National Institutes of Health (NIH). November 2011.

• Kidney cancer. National Kidney Foundation. 

• Dahl DO, et al. Renal cell carcinoma and kidney transplantation: A narrative review. Transplantation. January 2022.

• Transplant trends. United Network for Organ Sharing (UNOS). January 2022.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.