Clinical Significance of Gastric Cancer Surveillance in Renal Transplant Recipients

Posttransplant malignancy is one of the major causes inhibiting long-term graft survival. Gastric adenocarcinoma is the most common malignancy in Korea and occurs more frequently in renal transplant recipients compared to that in Western countries. We aimed to analyze the clinical features of the post-renal-transplant gastric cancer and assess factors that can affect the difference in survival. Of the 2,157 recipients who underwent renal transplantation at Asan Medical Center between January 1992 and April 2008, the 13 patients diagnosed with gastric adenocarcinoma after transplantation were retrospectively reviewed. We analyzed the effects of primary disease causing end-stage renal disease, type of donor, type of immunosuppressant, induction therapy, and organ rejection on survival after cancer diagnosis. In addition, we evaluated the need for regular gastric cancer screening after transplantation by analyzing the difference in survival between the patients who were and were not screened on a regular basis. Gastric adenocarcinoma occurred 3.44 times more often in men and 8.33 times more often in women than in the same age group of the general population in Korea (176.4/100,000 in men and 67.6/100,000 in women). Except for endoscopic screening, survival had no relation to the primary disease, type of donor, type of immunosuppressive drug, induction therapy, or the presence of rejection. The 5-year survival rates of recipients who were and were not screened by regular gastroscopic surveillance were 100 and 53.6 %, respectively (p = 0.06). Regular gastric surveillance might be needed for renal transplant recipients with a high risk of gastric malignancy.