Article

Cancer mortality in kidney transplantation.

Department of Medicine, Dalhousie University, Halifax Nova Scotia, British Columbia, Canada.
American Journal of Transplantation (impact factor: 6.39). 07/2009; 9(8):1868-75. DOI:10.1111/j.1600-6143.2009.02728.x pp.1868-75
Source: PubMed

ABSTRACT Immunosuppression is associated with an increased risk of cancer in kidney transplant recipients compared to the general population. It is less clear whether standardized cancer mortality ratios (SMRs) are also increased. This study's hypothesis is that SMRs are not increased because of competing risks of death. During the median follow-up of 5.05 years (Q1-Q3: 2.36-8.62), there were 1937 cancer deaths and 36 619 noncancer deaths among 164 078 first kidney-only transplant recipients captured in the United States Renal Data System between January 1990 and December 2004. The observed cancer death rate was 206 per 100 000 patient-years compared to an expected rate of 215 per 100,000 patient-years in the general population. The overall age- and sex-adjusted SMR was only 0.96 (95% CI 0.92-1.00). However, patients <50 years had SMRs significantly greater than unity while patients >60 had SMRs lower than unity. Up to 25% of cancer-related deaths occurred after allograft failure. These findings challenge the notion that cancer is a major cause of premature death in all kidney transplant recipients and has implications for design of cancer prevention strategies in kidney transplant recipients.

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    Article: Incidence of Primary and Second Cancers in Renal Transplant Recipients: A Multicenter Cohort Study.
    G Tessari, L Naldi, L Boschiero, E Minetti, S Sandrini, F Nacchia, F Valerio, C Rugiu, F Sassi, E Gotti, L Fonte, G Talamini, G Girolomoni
    [show abstract] [hide abstract]
    ABSTRACT: Limited data exist about cancer prognosis and the development of second cancers in renal transplant recipients. In a retrospective cohort study on 3537 patients incidence rates of the first and, if any, of a second cancer, and standardized incidence ratios [SIR (95% CI)] were computed. Two hundred and sixty-three (7.5%) patients developed a NMSC, and 253 (7.2%) another type of cancer after a median follow-up of 6.5 and 9.0 years, respectively. A statistically significant excess risk, if compared to an age- and sex-matched reference general population, was observed for Kaposi sarcoma and NMSC, followed by non-Hodgkin lymphoma and carcinoma of cervix uteri; a small number of unusual cancers such as tumors of the salivary glands, small intestine and thyroid also were detected at a level worthy of additional scrutiny. Ten-year survival rate of all noncutaneous cancers was 71.3%, with lower rates for lung carcinoma and non-Hodgkin lymphoma (0% and 41.7%, respectively). Patients with NMSC had an increased risk of developing a second NMSC [SIR 8.3 (7.0-10.0)], and patients with a primary noncutaneous cancer had increased risk of developing a second noncutaneous cancer [SIR 1.8 (1.2-2.8)], if compared to the whole cohort. Our study underscore that the high risk of primary and second cancer in renal transplant recipients, including unusual cancers.
    American Journal of Transplantation 10/2012; · 6.39 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

164 078 first kidney-only transplant recipients
 
36 619 noncancer deaths
 
allograft failure
 
cancer prevention strategies
 
cancer-related deaths
 
findings challenge
 
general population
 
implications
 
kidney transplant recipients
 
median follow-up
 
observed cancer death rate
 
patients <50 years
 
sex-adjusted SMR
 
standardized cancer mortality ratios
 
study's hypothesis
 
United States Renal Data System