Increasing success in organ transplantation, longer graft and patient survival malignancies are becoming a major burden in transplantation medicine.
There is now convincing evidence to confirm a 3- to 5-fold increase in overall cancer incidence.
Duration and intensity of immunosuppression have been linked to the increased incidence of malignancies and the choice of immunosuppressive therapy could also play a role in the development of cancer.
It is mandatory to understand how and when the tumoral process began and if a screening program could be established. Considering the poor outcome of transplanted patients that develop a tumour process, immunosuppression dose reduction or withdrawal is sometimes necessary to control the progression of life-threatening malignancies maintaining, when possible, graft function.
A conversion from CNI to PSI, although is not curative, could be potentially helpful to prolong survival in some patients. Transplant recipients with evidence of cancer should be offered the best medical and surgical oncology treatment in addition to the choice of immunosuppressive therapy.
Those patients in whom the neoplastic process is advanced and life expectance is really poor probably could not have any clinical advantage reducing or stopping immunosuppressive therapy, adding at cancer disease the risk of acute rejection and graft loss.