Kidney Transplant Recipient With Testicular Cancer
My patient is a 45-year-old man who is a kidney transplant recipient (2000) with good graft function and who was recently diagnosed with stage I left testicular carcinoma. How should I manage his immunosuppression?

Y. Abbas, MD

I believe that, in contrast to posttransplant lymphoproliferative disorder, in which stopping immunosuppression is the cornerstone of therapy, stopping immunosuppression will not make the testicular cancer go away. I would minimize immunosuppression and try to achieve low-dose calcineurin inhibitor therapy, stopping adjunctive agents, such as sirolimus or mycophenolate mofetil, and try to stop or minimize corticosteroids. If the oncologists have specific recommendations, I would follow those.