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

Table 10 Post-transplant malignancy: surveillance protocols[30]

Cancer	Post-transplant surveillance
Skin	Self-skin examination monthly; examination by dermatologist: 6 to 12 monthly[162] (expert opinion)
PTLD (EBV+)	Routine screening of EBV D+/R- by EBV NAAT: once first week, monthly for next 3–6 mo, and every 3 mo till 1 yr after transplantation[162] (expert opinion)
Cervical	Age 25–74 yr: yearly cervical Pap test and pelvic examination[195]; in higher risk category, more frequent Pap test
Hepatocellular	Every 6 mo screening with USG ± α-fetoprotein in high risk (i.e. with cirrhosis) (extrapolation from general population)
Renal	USG screen every 6–12 mo in high risk (i.e. acquired cystic kidney)[196]
Breast	Females < 50 yr: individual decision when to start screening; Females 50–74 yr: every 2 yr screening mammography[197]; [extrapolation from immunocompetent (general) population]
Prostate	Men 55–69 yr: individualized screening approach after discussing potential benefits and harm; Men > 70 yr, avoid routine screening[198] [extrapolation from immunocompetent (general) population]
Bowel	All 45–75 yr: stool immunochemical testing every 2 yr, 5-yearly FEGD and sigmoidoscopy, or 5–10-yearly colonoscopy[199]
Lung	All 55–79 yr who have smoked 1 pack/day for 30 yr or its equivalent (2 packs/day for 15 yr, 3 packs/day 10 yr): yearly low dose CT chest [200] [extrapolation from immunocompetent (general) population]

PTLD: Post-transplant lymphoproliferative disorders; EBV: Epstein–Barr virus; NAAT: Nucleic acid amplification test; USG: Ultrasonography; FEGD: Fibreoptic esophago-gastroduodenoscopy; CT: Computed tomography.