Organ transplantation is followed by an increased risk for development of cancer. Analyses of materials from transplanted and therefore immunosuppressed patients allow the possibility to find risk factors for cancer and to evaluate oncogenetic mechanisms in general.
In our most recent analyses performed using correct cancer epidemiological methods an increased incidence of 3 - 5 times that in the general population has been found, including most types of tumours, however with an uneven pattern with emphasis on lip- cervical-, vulvar-, urological-, skin-cancers and lymphoproliferative disorders (PTLD). Most tumours occur early (include. PTLD) after transplantation, tumours of the skin however later and with an increase with time.
This complication appears to be increasing in degree for all types of organ transplantation, however a parallel increase in our knowledge concerning possible risk factors and oncogenetic mechanisms in general. Many of the tumours appear to be associated in some way with virus infections, thus opening up for possible new approaches to prophylaxis and treatment.
Based on previous cancer epidemiological studies in the Nordic countries it is the aim of this new study to :
1. perform a follow-up on existing files on kidney transplanted patients in the Nordic countries to latest possible date in the framework of Scandiotransplant and the Association of the Nordic cancer Registries
2. to analyse the Nordic material concerning all types of organ transplantation to latest possible date in the framework of Scandiatransplant and the Association of the Nordic Cancer Registries (ANCR)
3. to start a prospective registry with extensive use of existing data files in the Scandiatransplant organisation and the Association of the Nordic Cancer Registries (ANCR) allowing yearly analysis, with 1-3 in a collaborative study including all Nordic transplantation centres and cancer registries
4. to perform a study of cancer in patients on dialysis in the European Institute of Oncology, Division of Epidemiology and Biostatistics in Milano, Italy, which co-operates with centres in many European countries, since this will be complementary to the transplant study, as these patients are uremic with depressed immune defence, however not transplanted and immunosuppressed by drugs.
The cancer epidemiological analysis will allow identification of cases to be analysed intensively in :
5. specialised laboratories for immune pathology (DK, GB), cytokines (DK), virology (DK), and tissue typing (DK, FI, N, SE)
6. identified cases with proved Epstein-Barr oncogenetic background will be treated with a combination of (a) intravenous high-dose aciclovir and (b) decreased or discontinued immunosuppression.
The overall aim is to bring together cancer epidemiology (in the Nordic countries and Italy) with new advances in cellular, molecular and developmental genetics in immunopathology and immunology (cytokines and tissue types) and virology in order to obtain new biological insights and improvements in both diagnosis and treatment of interest for the field of transplantation and thereby also to obtain new insights in oncogenesis per se.