Paraneoplastic Syndrome After Kidney Transplantation: Frequency, Risk Factors, Differences to Paraneoplastic Occurrence of Glomerulonephritis in the Native Kidney, and Implications on Long-Term Kidney Graft Function

Abstract

Glomerulonephritis; Paraneoplastic syndrome; Transplantation

Glomerulonefritis; Síndrome paraneoplàsica; Ttrasplantament

Glomerulonefritis; Síndrome paraneoplásico; Trasplante

Posttransplant malignancies are an important complication of solid organ transplantation. Kidney transplant recipients are at particularly high risk of cancer development. The most relevant risk factors of carcinogenesis are the use of immunosuppressive agents and oncogenic viral infections. Additionally, immune dysregulation caused by these factors may predispose to various types of organ damage. Paraneoplastic glomerular diseases are one of the most interesting and understudied cancer manifestations. The appropriate diagnosis of paraneoplastic glomerular damage can be challenging in kidney transplant recipients, due to factors inherent to concomitant medication and common comorbidities. Recent advances in the field of molecular and clinical nephrology led to a significant improvement in our understanding of glomerular diseases and their more targeted treatment. On the other hand, introduction of novel anticancer drugs tremendously increased patients’ survival, at the cost of kidney-related side effects. Our review aims to provide insights into diagnosis and treatment of paraneoplastic glomerular diseases, with a special attention to kidney transplant recipients.

The authors declare that financial support was received for the research, authorship, and/or publication of this article. MS is supported by grants from Fondo de Investigación Sanitaria-FEDER, ISCIII, PI17/00257, PI20/00744, PI21/01292, Marató TV3 2020 421/C/2020, Marató TV3 2021 215/C/2021, RD16/0009/0030 (REDINREN), BECA SENFRO 2021, RD21/0005/0016 (RICORS 2040), and ERA-PerMed-JTC 2022 (ONAKI-ICI AC22/00029).