Kidney transplant offers similar survival in patients with ESKD vs ESKD, prostate cancer
Click Here to Manage Email Alerts
Among patients with end-stage kidney disease, researchers found the same degree of survival benefit from kidney transplant for those with and those without prostate cancer, noting the cancer was linked with modest increases in mortality.
The retrospective population-based study assessed 588,478 men (ages 40 to 79 years) with ESKD who were enrolled in Medicare Part A and B. Overall, 18,162 men (3.1%) were diagnosed with prostate cancer before a kidney transplant and after the initiation of dialysis.
“In this study of ESKD patients, our primary objective was to examine how mortality is influenced by a diagnosis of prostate cancer and a subsequent kidney transplant,” Nagaraju Sarabu, MD, MPH, and colleagues wrote in the study published in Kidney Medicine. “Our secondary objective was to examine the influence of prostate cancer diagnosis on time to kidney transplant.”
Researchers collected data from 1999 to 2015 using the United States Renal Data System and used propensity score matching to control for confounding variables. They used the Kaplan-Meier method to “generate survival curves for time to death and cumulative incidence curves for time to kidney transplant” and used the log-rank test to find significant differences between groups of patients. Researchers assessed time to death by generating curves determined by kidney transplant status along with prostate cancer. Survival rates of patients with prostate cancer were compared with those without prostate cancer at 1-, 3- and 5-year follow-up. The control group was defined as patients with ESKD without prostate cancer.
Patients with prostate cancer tended to be older, with 48% being older than 70 years old compared with 28% in the cancer-free control group, according to the study. Patients with prostate cancer were also more likely to be Black and less likely to be Hispanic, less likely to start hemodialysis with a catheter as access, less likely to have diabetes and peripheral vascular disease, and had a lower BMI.
Compared with controls, prostate cancer was associated with a 22% lower likelihood of kidney transplant (HR = 0.78; 95% CI, 0.72-0.85) and 11% higher likelihood of death (HR = 1.11; 95% CI, 1.08-1.14).
According to the study, kidney transplant was associated with “fourfold” overall survival improvement in patients with and those without prostate cancer (HR = 0.20; 95% CI, 0.18-0.21). Researchers found reduced mortality attributed to kidney transplantation was the same in patients with and those without prostate cancer, showing no negative effects of post-transplant mortality and reinforcing the benefits of kidney transplant in patients with ESKD.
For the group with prostate cancer, survival at 1 year, 3 years and 5 years was 76%, 48% and 43%, respectively. Survival for the group without prostate cancer was 80% at 1 year, 51% at 3 years and 33% at 5 years.
“[P]rostate cancer in ESKD is associated with only modest increase in mortality and delay in kidney transplant,” Sarabu and colleagues wrote. “Kidney transplant is associated with similar survival benefit irrespective of if the patients had prostate cancer prior to kidney transplant. [F]ew prostate cancer patients died of cancer.”
“The clinical implications are primarily for the referring doctors to realize that benefits of kidney transplantation outweigh risks of cancer progression in most ESKD patients with prostate cancer,” Sarabu told Healio. “The findings of the study are rather expected to me as a transplant professional, but now we have evidence that can serve as basis for our clinical practice and for future studies."
Investigators noted future research is needed on the benefits of avoiding progression of cancer due to immunosuppression, as well as the impact of delaying transplantation on balancing risks of increased mortality associated with remaining on dialysis.
Collapse
Read more about
Click Here to Manage Email Alerts