No improvements seen in cancer incidence after kidney transplant during 3-decade period
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A study of U.S. kidney transplant recipients showed no significant changes in cancer incidence during a period of 3 decades, with rates of graft failure and mortality remaining high.
According to Christopher D. Blosser, MD, of the University of Washington Medical Center, and colleagues, kidney transplant recipients have an elevated risk for various types of cancers due to immunosuppressive medications prescribed to prevent graft rejection, as well as the carcinogenic effects of other commonly prescribed medications.
“Contemporary health care has improved post-transplant disease management, resulting in longer graft survival as well as a decrease in overall morbidity and mortality due to two of the leading causes of death — cardiovascular disease and infection,” the researchers wrote.
To determine whether improvements in both transplant care and cancer treatment over time have led to reduced cancer incidence and better outcomes for transplant recipients, Blosser and colleagues linked U.S. transplant and cancer registry data, including a final cohort of 101,014 individuals. Outcomes were compared between three periods (1987 to 1996, 1997 to 2006 and 2007 to 2016), with focus placed on six common types of cancer (lung cancer, melanoma, colorectal cancer, kidney cancer, prostate cancer and non-Hodgkin lymphoma).
Researchers noted the “recipients in this study were similar to the changing U.S. [kidney transplant recipient] KTR population.” More specifically, they observed an increase in age at transplantation over time (mean age 44.3, 48.6, and 50.9 years for transplants in 1987 to 1996, 1997 to 2006 and 2007 to 2016, respectively), “growing racial/ethnic diversity,” along with increasing BMI and prevalence of end-stage kidney disease due to diabetes or hypertension.
Throughout the entire study period of 1987 to 2016, Blosser and colleagues found no significant change in the incidence of cancer overall for the six common cancers, though the incidence of prostate cancer decreased significantly after multivariate adjustment, and the incidence of kidney cancer increased in the unadjusted analysis.
“Most kidney cancers are renal cell carcinomas and among KTRs occur in the native kidneys in association with acquired cystic kidney disease,” the researchers wrote. “The rise in kidney cancer incidence over time could partly reflect the increasing age at transplantation, prior waitlist time and body mass index in the KTR population, since all are risk factors for renal cell carcinoma.”
Further findings indicated declines over time in elevated risks for death-censored graft failure (DCGF) and death with failing graft (DWFG) for patients with non-Hodgkin lymphoma; this decrease was not seen for other combined cancers.
For recipients transplanted in the most recent period (2007 to 2016), risks following cancer diagnosis remained high, with 38% experiencing DWFG and 14% experiencing graft failure within 4 years of cancer diagnosis. Absolute risk of death with failing graft appeared to be “especially high” in patients who developed lung cancer (78%), non-Hodgkin lymphoma (38%), melanoma (35%) and colorectal cancer (49%).
“Unfortunately, there has been no major change in cancer incidence among KTRs in the U.S. over the last 3 decades, and only KTRs with [non-Hodgkin lymphoma] NHL have experienced declines in the relative risks for death and graft failure over time,” Blosser and colleagues concluded of the findings. “Moreover, absolute risks of DWFG and graft failure remain high for KTRs with cancer, including those with NHL. These findings highlight the need for research on cancer screening, diagnostics, and therapeutics to enable more timely and accurate diagnoses and improve curative treatments in kidney transplant recipients.”
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