SP612SUBTOTAL PARATHYROIDECTOMY VERSUS TOTAL PARATHYROIDECTOMY WITH AUTOTRANSPLANTATION IN SECONDARY HYPERPARATHYROIDISM – THE LONG-TERM OUTCOMES (SINGLE CENTER EXPERIENCE)

INTRODUCTION: The development of new and more effective immunosuppressive agents has provided long-term survival for transplant recipients, thereby increasing the risk of de novo malignancies. While de novo post-transplant lymphoproliferative diseases and skin cancer have been shown to have an increased incidence in long-term surviving solid organ transplant recipients, the association with gastrointestinal (GI) cancer is controversial. METHODS: data about kidney transplant recipients followed in Clinical Hospital Center Zagreb with de novo GI tumors developed after kidney transplantation. RESULTS: Gastrointestinal tumors were diagnosed in 14 out of 1990 patients in the period of 45 years. Ten patients (71,4%) were male. Average age at the time of diagnosis of GI tumors after kidney transplantation was 58,7 years. Average time after kidney transplantation until the diagnosis of GIT tumors was 12 (range 1 to 27) years after the transplantation. In 5 patients (35,7%) colorectal carcinoma was diagnosed; in 3 patients (21,4%) pancreatic adenocarcinoma, in 2 patients (14,2%) cholangiocarcinoma, in 1 patient (7,1%) papillary adenocarcinoma of the stomach, in 2 patients (14,2%) carcinoid tumor of appendix and in one patient (7,1%) GIST (gastrointestinal stromal tumor) of the stomach and small intestine. Immunosuppressive regimen after kidney transplantation consisted of CIN inhibitors (cyclosporine in 8 patients – 57,1% and tacrolimus in 6 patients 42,9%), mycophenolate mofetil and steroid and all patient after diagnosis of GIT tumor were converted to mTOR inhibitors therapy (sirolimus in one patient and everolimus in 13 patients). One of the patients with pancreatic adenocarcinoma also developed recidivant planocellular skin cancer and PTLD (post-transplant lymphoproliferative disease). Specific oncologic treatment (chemotherapy) was conducted in 8 patient (57,1%). Survival rate was was 42,8%. Despite malignant disease and nephrotoxic chemotherapy, graft survival rate over the same time was 85,7% (12 patients); 2 patients lost graft function and returned to chronic hemodialysis treatment. One of 14 patients had CMV reactivation early after kidney transplantation (in the first trimester after kidney tx); and the same patient developed carcinoid tumor of appendix afterwards. CONCLUSIONS: Although kidney transplant recipients have higher risk of malignant disease, GISTs occurring in the kidney transplant recipient are rarely described in the literature. We suggest a closer follow-up for de novo GI cancer in renal transplant recipients in order to avoid delayed diagnosis and complications. Some investigations suggest a closer follow up for de novo GI cancers in renal transplants with early CMV and EBV reactivation.