09. PTC: Cancer Risks for Pancreas Recipients

All organ transplant recipients are at heightened risk of developing cancer after transplant. This is because although life-sustaining, long-term use of immunosuppressant drugs lowers the body’s ability to fend off certain cancers. When you are taking immunosuppressant drugs, your immune response is lowered, and this is what helps to prevent your body from rejecting your new pancreas. It also means that your body is less able to recognize and destroy cancer cells or infections that can cause cancer.

Additionally, because immunosuppressant drugs reduce your body’s natural monitoring and disease response, you are at increased risk of developing certain viral infections that are linked to increased cancer risk. Examples of these viruses include the Epstein-Barr virus which is associated with lymphoma, Hepatitis which is linked to liver cancer, the Herpes virus which is associated with Kaposi sarcoma, and the Human Papilloma Virus that is associated with skin cancers. There is also a very small chance that cancer was already present in the transplanted organ.

Note: For full versions of any of the INTRO video clips below, go to the full library of ONLINE resources at https://www.triowebptc.org/link/resource-library.html

For all people, cancer risk increases as a natural part of the aging process. For pancreas transplant recipients, you are most at risk for infections that could possibly lead to cancer during the first 3-6 months after transplant. The overall risk for cancer increases with each year of immunosuppressant drug use. This means that the longer pancreas transplant recipients survive post-transplant, the greater the incidence of cancer. There are also certain lifestyle choices that can raise your risk of cancer, such as not getting regular exercise, weight gain, smoking/tobacco use, alcohol use or having a poor diet. Importantly, those who have diabetes are at an especially high risk of developing cancer after transplant. Explore the LOOK pages to learn more about each of these types of cancer and how to manage your risk.

• Skin Cancer: According to Family Practice News, research has found that people who have received a Pancreas transplant have a cumulative incidence of skin cancer 10 years after transplant that is about 20%. This means that with each year after transplant, your risk of developing skin cancer increases up to 20% after 10 years. Another notable finding was that recipients who developed squamous cell carcinoma, a specific type of skin cancer, were 56% more likely to develop a second one within 2 years. People who developed basal cell carcinoma, another specific type of skin cancer, were 36% more likely to develop a second one within 2 years. The risk of developing skin cancer after a pancreas transplant increases with age.

• Post-transplant Lymphoproliferative Disease (PTLD): Lymphomas are cancers of the white blood cells also known as PTLD. These can present in a single location or multiple locations, including the bone marrow, brain, digestive tract, allograft, or liver. Many cases of PTLD are associated with the Epstein-Barr virus, a member of the herpes virus family. Recent research from scientists at the University of Minnesota found that about 100 people or 5% of people in a study that had about 2300 people developed PTLD. Of that 5%, the most common time that it showed up was within 6 months of the transplant. One other thing that increased the risk of PTLD was if the person had a history of rejection. Other research by Dr. Issa and colleagues found that order of transplant, like if you did kidneys first, or both at the same time, or just pancreas did not matter for the amount of risk of PTLD.

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