La inmunosupresión como causa del cáncer: Presentación de un caso y revisión de la terapia inmunosupresora en pacientes con trasplante renal

Introduction: Spain is a world leader in kidney transplants. After an organ transplant, the patient will need to take immunosuppressant (anti- rejection) drugs. These drugs help prevent its immune system from attacking ("rejecting") the donor organ. Typically, they must be taken for the lifetime of your transplanted organ. The incidence of malignant tumors in patients with kidney transplant is greater than in the general population. The degree of immunosuppression in the development of melanoma in patients with kidney transplant is a factor of risk and it could be associated with the type of anti-rejection drugs. Clinical Case: Man 70 years old, a kidney transplant was performed in 2011 and he was treated with immunossupressive drugs. After 4 years of treatment, the patient developed a non-mutated metastatic BRAF melanoma, with a single metastatic lesion in the lung. Then, he switched to Everolimus and suspended Tacrolimus. The initial cancer treatment was the surgical resection in several times. However, immunosuppression allowed its tumor progression one year after the last surgery. Discussion: In patients with kidney transplant due to their treatment with immunosuppressive drugs to avoid rejection, it is essential to monitor them throughout their lives due to the risk of developing cancer. The inhibitors of the m-TOR pathway have been shown to have a lower risk of the appearance of neoplasms, as they are a pathway for the activation of some tumors. Therefore, its inhibition is used as an antineoplastic drug. But, in addition, they maintain their immunosuppressive activity allowing their use to avoid rejection in special situations, such as the case we present. Conclusions: The immunosuppression maintained by immunosuppressive drugs can be the cause of the development of tumors. Therefore, this situation can modify the oncological therapeutic management. The new immunosuppressive drugs used in kidney transplantation can reduce the incidence of cancer