Post-transplant malignancy: Focusing on virus-associated etiologies, pathogenesis, evidence-based management algorithms, present status of adoptive immunotherapy and future directions

Abstract

Modern immunosuppression has led to a decrease in rejection rates and improved survival rates after solid organ transplantation. Increasing the potency of immunosuppression promotes post-transplant viral infections and associated cancers by impairing immune response against viruses and cancer immunoediting. This review reflects the magnitude, etiology and immunological characteristics of various virus-related post-transplant malignancies, emphasizing the need for future research. A multidisciplinary and strategic approach may serve best but overall literature evidence targeting it is sparse. However, the authors attempted to provide a more detailed update of the literature consensus for the prevention, diagnosis, management and surveillance of post-transplant viral infections and associated malignancies, with a focus on the current role of adoptive immunotherapy and the way forward. In order to achieve long-term patient and graft survival as well as superior post-transplant outcomes, collaborative research on holistic care of organ recipients is imperative.

Keywords: Post-transplant malignancy management, Post-transplant virus-associated malignancy, Cancer, Kidney transplantation, Solid organ transplantation, Virus

Core Tip: Post-transplant malignancy poses a serious threat with increased risk in organ recipients, varying with the intensity of net immunosuppression. Various virus infections are either causative or associative or promote the development of post-transplant malignancies. It is crucial to be aware of different viral infections so as to pre-emptively screen viral infections and survey for post-transplant cancers, helping early diagnosis, thereby favoring improved outcomes and graft survival. Transplant clinicians must be up to date on current management strategies with the vital role of immunosuppression reduction and options like antivirals, rituximab, chemotherapy, adoptive immunotherapy, topical therapy and surgery based on individual case characteristics.