E5

(excluding KS) and renal carcinomas.3,4 The major part of this report is based on material collected by the CTTR up till January 1999, when it had received information on 11,017 organ allograft recipients who developed 11,729 types of de novo malignancy (Table E5.1).

The incidence of tumors increases with length of follow-up posttransplantation. An Australian study of 6596 patients shows that the percent probability of developing cancer following renal transplantation from cadaver donors 24 years postoperatively is 66% for skin neoplasms, 27% for nonskin cancers and 72% for any type of tumor.5 These exceptional figures must be interpreted with caution as most cancers are skin malignancies (which are very common in Australia) and the number of 24-year survivors is small. Nevertheless, they emphasize the need to follow transplant patients indefinitely. Cancers occur a relatively short time posttransplantation with KS appearing at an average of 21 (median 13) months posttransplantation, PTLDs at an average of 34 (median 13) months, and vulvar and perineal carcinomas appearing at the longest time posttransplantation, at an average of 115 (median 114) months.3,4 If all tumors are considered the average time of their appearance is 63 (median 47) months.

Malignancies that occur in organ allograft recipients frequently demonstrate more aggressive behavior than do similar cancers in the nontransplant population.6

The most common tumors affect the skin and lips and comprise 37% of all neoplasms in the CTTR.3,4 They occur on sun exposed areas, mainly of the head

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