Onco-nephrology in kidney transplant recipients: challenges and evolving strategies

Cancer is a significant cause of mortality in kidney transplant recipients (KTr). Specifically, the relationship between cancer and kidney transplantation (KTx) is evident from the initial evaluation of CKD patients prior to their placement on the KTx waiting list. After KTx, a significant impact on the potential development of cancer is linked to immunosuppressive therapies, necessary to maintain renal function post-KTx, and to complications, especially infectious ones, typical of these patients. Ultimately, once cancer is diagnosed in a KTx, nephrologists and transplant specialists are forced to modulate suppressive therapies and, together with oncologists, manage specific cancer treatment therapies. In this highly complex scenario, unfortunately, there are few certainties, and they are limited to a few studies, often involving a small number of patients. This review integrates current data on risk, prevention, and treatment across the entire pathway: pre-transplant assessment, post-transplant surveillance, and management after a cancer diagnosis. A special focus will be reserved to the new evidences regarding the treatment with immune-checkpoint inhibitors (ICIs).