[Lympho- and myeloproliferative disorders in renal transplant recipients--one center's experience and review of the literature].

Recipients of renal transplants have an increased risk of developing secondary malignancies. About 4% of patients who underwent kidney transplantation will develop cancer, and 1% of transplanted patients will develop lymphoproliferative disorders. According to clinical analyses and laboratory data, the main reason for increased risk of developing malignant disease in this group of patients, is their immunocompromised status due to immunosuppressive treatment. So called "strong" immunosuppressive drugs like antilymphocytic globulin (ALG), antithymocytic globulin (ATG), or monoclonal globulin OKT3 seem to favor the development of secondary malignancies much more than other drugs, like: corticosteroids, azathioprine (AZA), or cyclosporine (CsA). Secondary lymphoproliferative disorders are usually connected with reactivation of Ebstein-Barr virus infection. Patients with early onset (<1 year after the transplantation) have a favorable clinical course after withdrawal of immunosuppression. The subset of late-onset (>1 year) has usually much more aggressive clinical course and patients require intensive treatment. The general recommendation in these patients is to stop or to reduce the immunosuppressive treatment and to continue the chemotherapy in full dose. This treatment is often complicated by severe infections, but it offers a chance to achieve remission without worsening the function of transplanted organ. In this paper we are presenting five patients with secondary lympho- or myeloproliferative disorders after kidney transplantation and give an overview of the recent literature in this field.