Cancer‐attributable mortality among solid organ transplant recipients in the United States: 1987 through 2014

Abstract

Background Solid organ transplant recipients have an elevated risk of cancer. Quantifying deaths attributable to cancer can inform priorities to reduce cancer burden. Methods Linked transplantation and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987‐2014). Population‐attributable fractions (PAFs) of deaths due to cancer and corresponding cancer‐attributable mortality rates were estimated using Cox models. Results Among 221,962 solid organ transplant recipients, 15,012 developed cancer. Approximately 13% of deaths (PAF, 13.2%) were attributable to cancer, corresponding to a cancer‐attributable mortality rate of 516 per 100,000 person‐years. Lung cancer was the largest contributor to mortality (PAF, 3.1%), followed by non‐Hodgkin lymphoma (NHL; PAF, 1.9%), colorectal cancer (PAF, 0.7%), and kidney cancer (PAF, 0.5%). Cancer‐attributable mortality rates increased with age at transplantation, reaching 1229 per 100,000 person‐years among recipients aged ≥65 years. NHL was the largest contributor among children (PAF, 4.1%) and lung cancer was the largest contributor among recipients aged ≥50 years (PAFs, 3.7%‐4.3%). Heart recipients had the highest PAF (16.4%), but lung recipients had the highest cancer‐attributable mortality rate (1241 per 100,000 person‐years). Overall, mortality attributable to cancer increased steadily with longer time since transplantation, reaching 15.7% of deaths (810 per 100,000 person‐years) at ≥10 years after transplantation. Comparison of cancer‐attributable mortality rates with specified causes of death indicated that some deaths recorded as other causes might instead be caused by cancer or its treatment. Conclusions Cancer is a substantial cause of mortality among solid organ transplant recipients, with major contributions reported from lung cancer and NHL. Cancer‐attributable mortality increases with age and time since transplantation, and therefore cancer deaths will become an increasing burden as recipients live longer.

De-novo malignancies after kidney transplantation: A long-term observational study

“…The present data also showed significantly worse survival in the tumour-group, both after KT (Fig 3) and after tumour diagnosis (Fig 4). Similar to earlier investigations, mortality after tumour diagnosis was elevated [20,32]. However, the differences to matched PLOS ONE controls were mainly seen within the first years after diagnosis and mortality rates became similar later (Table 3; Fig 4).…”

Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement

“…The primary barrier for consideration of solid organ transplantation (SOT) in patients with pretransplant malignancy (PTM) is the concern that immunosuppression amplifies the risk of cancer recurrence, potentially impacting posttransplant mortality. While it is clear that immunosuppression administered to SOT recipients is associated with an increased likelihood of de novo cancer, 1 clinical evidence on the safety of immunosuppression in the circumstance of PTM is limited.…”

Elevated incidence of head and neck cancer in solid organ transplant recipients

“…Unfortunately, this population of transplant recipients have been shown to have an increased risk of subsequently developing a range of cancers . Despite the fact that solid organ transplant recipients are vulnerable to a number of medical comorbidities, cancer is the second leading cause of death for such patients, accounting for 13% of deaths in one recent study of 221 962 patients . The most common posttransplant malignancies include skin cancers, lymphoproliferative disorders, and lung cancer .…”

“…[2][3][4] Despite the fact that solid organ transplant recipients are vulnerable to a number of medical comorbidities, cancer is the second leading cause of death for such patients, accounting for 13% of deaths in one recent study of 221 962 patients. [4][5][6] The most common posttransplant malignancies include skin cancers, lymphoproliferative disorders, and lung cancer. 3 Several studies have also demonstrated increased risk of head and neck cancers; in particular, oral cavity, oropharynx, and thyroid cancers have been shown to be associated with prior solid organ transplant.…”

“…While several robust studies of cancer risk in transplant patients have been conducted, such studies typically have only included cohorts of transplant recipients and lacked a control group: thus, estimates of risk are based on population data. [3][4][5]14,20 This estimation could be problematic, as risks of various cancers may have changed considerably over time (both in the transplant population and general population); studies of cancer risk in transplant patients rely on longitudinal data, while estimates of cancer risk in the general population often represent a shorter period of time. The lack of a control group in prior studies, then, may result in inaccurate estimations of risk.…”