De Novo Testicular Cancers Arising After Renal Transplantation: A Narrative Review

Abstract

The use of immunosuppressive drugs that are needed to prevent graft loss is directly associated with an increased frequency of cancers, which are one of the main causes of morbidity and mortality in transplanted patients. Kidney transplant recipients (KTRs) face an approximately 0.4% risk of developing testicular cancer (TC), which represents a threefold increase compared to the general population. Seminomatous germ cell tumors are the most common histological subtype observed in these patients, even in those with an immunosuppressive state. However, the presentation and diagnosis of TC in KTRs align closely with those observed in the general population. In the studies reviewed here, the median age of KTRs at the time of TC diagnosis was 45 years, with a median post-transplant period of 5 years before diagnosis. The European Association of Urology's Kidney Transplantation guidelines do not offer specific recommendations regarding TC management in transplant recipients. Long-term immunosuppression is considered a significant risk factor, as transplant recipients face an increased likelihood of developing malignancies compared to patients undergoing dialysis. Clinically, most testicular tumors in KTRs present as localized, with a smaller proportion diagnosed at more advanced stages. Chemotherapy is often considered a safer alternative in such scenarios, with several reports demonstrating its effectiveness in treating metastatic disease in transplant recipients. Radiotherapy use in post-transplant patients presents challenges due to alterations in lymph node architecture following transplantation. Surgical procedures can disrupt normal lymphatic drainage, sometimes leading to partial lymphadenectomy. This study aims to provide an updated, comprehensive overview of the incidence, risk factors, and clinical management of TC in patients following renal transplantation.

Keywords: Testicular cancer; kidney transplant recipients; management; renal transplantation; review; seminoma.