[Infectious and neoplasic complications after kidney transplantation]

Abstract

Infections and malignancies are the expected complications of immunosuppressive therapy, which non-specifically impairs cellular and humoral immune responses in renal transplant recipients. Infections were usually frequent and severe during the early post-transplant period (first year). Recent diagnostic methods (molecular biology) and availability of new antivirals, antifungal and antibiotic drugs made rapid diagnosis and systematic preventive strategies much easier and this resulted in a significant reduction of infections and infectious death in this population. However, new infectious agents like BK polyomavirus, hepatitis E virus, parvovirus (as well as Chigunkunya, West Nile and others in particular areas) were recently recognized as responsible of aggressive infections in the immunocompromised host. Malignancies are also common after transplantation, due to the intensity and duration of immunosuppression. Skin cancers and lymphoproliferative disorders are the most common and are undoubtedly caused by viral infections, but incidence of non-skin cancers is also increased. After reduction of immunosuppression, treatment is similar to non-transplant patients: Results are usually poor and cancer is now the third cause of death in transplant recipients. Due to their anti-proliferative and anti-tumoral properties, incidence of de novo cancer significantly decreased in patients receiving mTor inhibitors as maintenance immunosuppression; furthermore, in patients already diagnosed with Kaposi sarcoma or recurrent skin cancers, introduction of mTor was associated with stabilisation and/or regression of malignant lesions.

Keywords: BK virus nephropathy; Carcinomes basocellulaires; Carcinomes spinocellulaires; Cytomegalovirus; Cytomégalovirus; Immunizations; Infections opportunistes; Mycobacterias; Mycobactéries; Néphropathie à BK virus; Opportunistic infections; Post-transplantation lymphoproliferative disorders (PTLD); Skin baso-cellular carcinoma; Skin squamous cell carcinoma; Syndromes lymphoprolifératifs post-transplantation (SLPT); Vaccinations.