Modern Immunosuppression. Risk Of Malignancy Development And Antiproliferative Effects

With the improvement in prognosis after transplantation, late complications have become increasingly important during postoperative care. Patients under immunosuppression have a 3-5-fold increased probability for malignancies. The risk depends on the intensity of immunosuppression and the distinct influence of the respective substances (and their combination) on tumor growth. Newer agents such as mTOR inhibitors and derivatives of mycophenolic acid may suppress tumor growth by their antiproliferative properties. In several clinical trials, a tumor-suppressing activity of mTOR inhibitors was proven. For derivatives of mycophenolic acid, experimental data suggest an advantageous influence on lymphoma development. In general, it must be assumed that no sufficient data from multicentric, randomized, controlled trials exist that could guide an evidence-based therapeutic strategy for the preferential application of certain substances or combinations to reduce risk of tumor development or to treat patients with an initially elevated risk of tumor. Patients at high risk for posttransplant malignancies should, if appropriate, be treated preferentially with an mTOR inhibitor. In patients with apparent tumor, a switch of immunosuppression may improve the prognosis. Mycophenolic acid should be considered in patients with posttransplant lymphoproliferative disease.