Elsevier

Kidney International

Volume 99, Issue 6, June 2021, Pages 1430-1438
Kidney International

Clinical Investigation
Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period

https://doi.org/10.1016/j.kint.2020.10.018Get rights and content

Recipients of kidney transplants have elevated cancer risk compared with the general population. Improvements over time in transplant care and cancer treatment may have affected incidence and outcomes of cancer among recipients of kidney transplant. To evaluate this, we used linked United States transplant and cancer registry data to study 101,014 adult recipients of kidney transplants over three decades (1987-1996, 1997-2006, 2007-2016). Poisson regression was used to assess trends in incidence for cancer overall and seven common cancers. Associations of cancer with risk of death-censored graft failure (DCGF) and death with functioning graft (DWFG) were evaluated with Cox regression. We also estimated absolute risks of DCGF and graft failure following cancer for recipients transplanted in 2007-2016. There was no significant change in the incidence of cancer overall or for six common cancers in recipients across the 1987-2016 period. Only the incidence of prostate cancer significantly decreased across this period after multivariate adjustment. Among recipients of kidney transplants with non-Hodgkin lymphoma, there were significant declines over time in elevated risks for DCGF and DWFG but no significant changes for other combined cancers. For recipients transplanted in the most recent period (2007-2016), risks following cancer diagnosis remained high, with 38% experiencing DWFG and 14% graft failure within four years of diagnosis. Absolute risk of DWFG was especially high following lung cancer (78%), non-Hodgkin lymphoma (38%), melanoma (35%), and colorectal cancer (49%). Thus, across a 30-year period in the United States, there was no overall change in cancer incidence among recipients of kidney transplants. Despite improvements for non-Hodgkin lymphoma, cancer remains a major cause of morbidity and mortality.

Section snippets

Results

We evaluated a cohort of 101,014 KTRs, with 351,127 person-years of follow-up over 3 decades of transplantation (1987–2016). Most KTRs were male (60.2%). Recipients in this study were similar to the changing US KTR population (Table 1). In particular, there was an increase in age at transplantation over time (mean age 44.3, 48.6, and 50.9 years for transplants in 1987–1996, 1997–2006, and 2007–2016, respectively) and growing racial/ethnic diversity. We also observed increasing body mass index

Discussion

Cancer continues to be a major cause of morbidity and mortality in KTRs. In the present study, there was no overall change in cancer incidence across a 30-year period in the United States. KTRs with NHL had improved outcomes over time, with declines in the relative risk of DWFG and DCGF, but there was no change in these associations for other cancers combined. Indeed, the absolute risks of DWFG and graft failure after cancer diagnosis remained high for the most recent KTRs who were transplanted

Methods

The Transplant Cancer Match Study (https://www.transplantmatch.cancer.gov) is a cohort study linking data on US solid organ transplant recipients from the Scientific Registry of Transplant Recipients (SRTR) with population-based cancer registries.3 At the time of this study, the Transplant Cancer Match Study included data for 1987 to 2016 from 18 state and metropolitan area cancer registries (see Table 1 footnote) covering approximately half of the US transplant population based on the state of

Disclosure

CDB has received honoraria from CareDx and Natera. All the other authors declared no competing interests.

Acknowledgments

This research was supported in part by the Intramural Research Program of the National Cancer Institute. We gratefully acknowledge the support and assistance provided by individuals at the Health Resources and Services Administration (Monica Lin), the Scientific Registry of Transplant Recipients (SRTR) (Ajay Israni, Bertram Kasiske, Paul Newkirk, and Jon Snyder), and the following cancer registries: the states of California (Tina Clarke), Colorado (Jack Finch), Connecticut (Lou Gonsalves),

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