Cancer in kidney transplantation: evaluation of donors and recipients

Cancer risk is a major consideration in kidney transplantation, owing both to the potential transmission of malignancies from the donor and to the increased incidence of cancer in transplant recipients. Careful donor selection, guided by the protocols of the Italian National Transplant Center, minimizes the risk of tumor transmission through comprehensive clinical, laboratory, and imaging assessments. At the same time, kidney transplant candidates should undergo cancer screening programs that combine recommendations for the general population with specific protocols tailored to patients with end-stage kidney disease. Among transplant recipients, the incidence of de novo malignancies is significantly higher than in the general population, primarily because of long-term immunosuppressive therapy. Therefore, lifelong oncological surveillance is essential. The integration of emerging precision medicine tools may further improve cancer risk stratification and optimize the clinical management of kidney transplant recipients.