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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Feb 6, 2015; 4(1): 41-56
Published online Feb 6, 2015. doi: 10.5527/wjn.v4.i1.41
Immune profiling and cancer post transplantation
Christopher Martin Hope, Patrick Toby H Coates, Robert Peter Carroll
Christopher Martin Hope, Patrick Toby H Coates, Robert Peter Carroll, Centre for Clinical and Experimental Transplantation, Central Northern Adelaide Renal and Transplantation Services, Adelaide SA 5000, Australia
Christopher Martin Hope, Patrick Toby H Coates, Robert Peter Carroll, Department of Medicine, the University of Adelaide, Adelaide SA 5000, Australia
Christopher Martin Hope, Central Northern Adelaide Renal and Transplant Services, Renal Lab, IMVS building, Royal Adelaide Hospital, Adelaide SA 5000, Australia
Author contributions: Hope CM planned, wrote and edited manuscript; Coates PTH critically revised and edited manuscript and Carroll RP organised, planned, co-wrote and edited manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christopher Martin Hope, PhD, Central Northern Adelaide Renal and Transplant Services, Renal Lab, IMVS building, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia. christopher.hope@health.sa.gov.au
Telephone: +61-8-82220976 Fax: +61-8-82220987
Received: July 11, 2014
Peer-review started: July 12, 2014
First decision: October 14, 2014
Revised: November 3, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: February 6, 2015
Processing time: 210 Days and 18.3 Hours
Abstract

Half of all long-term (> 10 year) australian kidney transplant recipients (KTR) will develop squamous cell carcinoma (SCC) or solid organ cancer (SOC), making cancer the leading cause of death with a functioning graft. At least 30% of KTR with a history of SCC or SOC will develop a subsequent SCC or SOC lesion. Pharmacological immunosuppression is a major contributor of the increased risk of cancer for KTR, with the cancer lesions themselves further adding to systemic immunosuppression and could explain, in part, these phenomena. Immune profiling includes; measuring immunosuppressive drug levels and pharmacokinetics, enumerating leucocytes and leucocyte subsets as well as testing leucocyte function in either an antigen specific or non-specific manner. Outputs can vary from assay to assay according to methods used. In this review we define the rationale behind post-transplant immune monitoring assays and focus on assays that associate and/or have the ability to predict cancer and rejection in the KTR. We find that immune monitoring can identify those KTR of developing multiple SCC lesions and provide evidence they may benefit from pharmacological immunosuppressive drug dose reductions. In these KTR risk of rejection needs to be assessed to determine if reduction of immunosuppression will not harm the graft.

Keywords: Immune-profiling; Immunosuppression; Kidney; Malignancy; Transplantation

Core tip: Kidney transplant recipients (KTR) with cancer have different leukocyte compartmentalisations and immune cell functions than KTR with no cancer. These differences can be used to determine KTR at risk of developing cancer and identify those who do not mount a reaction to their graft. Indicating there is a group of KTR that may benefit from pharmacological immunosuppressive drug dose reductions.