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Transplant recipients at increased risk for various cancer types
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Organ transplant recipients are at increased risk for various types of cancers, including infection-related cancers, compared with the general population, according to researchers for the Transplant Cancer Match Study.
“The large size of the Transplant Cancer Match Study allowed us to provide accurate estimates of risk for both common and rare cancers, and for the first time, carefully document the distribution of cancers among transplant recipients,” Eric A. Engels, MD, MPH, of the NCI said in an interview.
For the study, the researchers pooled data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients and 13 state and regional cancer registries. From 1987 to 2008, 175,732 solid organ transplants were identified; 58.4% were kidney transplants, 21.6% liver transplants, 10% heart transplants and 4% lung transplants.
The overall risk for cancer was increased with 10,656 cases and an incidence rate of 1,375/100,000 person-years (standardized incidence ratio [SIR]=2.10; 95% CI, 2.06-2.14).
Compared with the risk among the general population, there was an increased risk for 32 different malignancies among transplant recipients — some associated with known infections (anal cancer, Kaposi’s sarcoma), others were unrelated to infections (melanoma, thyroid and lip cancers), according to the study.
The most common malignancies associated with an increased risk were: non-Hodgkin’s lymphoma (n=1,504), with an incidence of 194/100,000 person-years (SIR=7.54; 95% CI, 7.17-7.93); lung cancers (n=1,344), with an incidence of 173.4/100,000 person-years (SIR=1.97; 95% CI, 1.86-2.08); liver cancers (n=930), with an incidence of 120/100,000 person-years (SIR=11.56; 95% CI, 10.83-12.33); and cancers of the kidney (n=752), with an incidence of 97/100,000 person-years (SIR=4.65; 95% CI, 4.32- 4.99).
Specifically, lung cancer risk was highest among lung transplant recipients (SIR=6.13; 95% CI, 5.18-7.21), but also increased among kidney transplant recipients (SIR=1.46; 95% CI, 1.34-1.59), liver transplant recipients (SIR=1.95; 95% CI, 1.74-2.19) and heart transplant recipients (SIR=2.67; 95% CI, 2.4-2.95).
The risk for kidney cancer was highest among kidney transplant recipients (SIR=6.66; 95% CI, 6.12-7.23) and also increased among liver transplant recipients (SIR=1.8; 95% CI, 1.4-2.29) and heart recipients (SIR=2.9; 95% CI, 2.32-3.59). The risk for liver cancer risk was increased only among liver transplant recipients (SIR=43.83; 95% CI, 40.9-46.91).
“Cancer is an important medical complication of solid organ transplantation,” Engels said. “Further efforts are needed to develop appropriate cancer prevention, screening and treatment approaches for the transplant population.”
For more information:
- Engels EA. JAMA. 2011;306:1891-1901.
Disclosure: During most of the period in which the study was conducted, the Scientific Registry of Transplant Recipients was managed by Arbor Research Collaborative for Health (contract HHSH234200537009C). Beginning in September 2010, the Scientific Registry of Transplant Recipients was managed by Minneapolis Medical Research Foundation (contract HHSH250201000018C).