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Why can long-term immunosuppression increase the risk of lymphoma?

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Kidney transplant — transplant British surgeon Andrew Ready flushing a donated kidney during a transplant at Queen Elizabeth Hospital, Birmingham, England, 2006.

Long-term immunosuppression, often required following transplant surgery to prevent organ rejection, increases the risk of lymphoma primarily by compromising the body's immune surveillance mechanisms.123

Under normal conditions, the immune system identifies and eliminates abnormal or malignant cells that arise within the body. When immunosuppressant drugs reduce the effectiveness of this defense, the body becomes less capable of controlling certain viral infections that can trigger cancer. Specifically, the Epstein-Barr virus (EBV) is a major factor; it infects B lymphocytes and can transform them into immortalized cells. In a healthy individual, the immune system typically keeps EBV-infected cells in check. However, in transplant patients with suppressed immunity, these infected B cells can proliferate excessively, potentially leading to the development of B-cell lymphomas.13245

It is a fundamental ethical principle in medicine to balance the life-saving benefits of preventing organ rejection against these known risks through careful clinical monitoring and management.2