Cancer in ESRD: Clear on the Epidemiology, Hazy on the Mechanisms

Lim, Wai H.; Chadban, Steven J.

doi:10.1681/asn.2015091021

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…While the incidence of cancer in this cohort was higher than that in other pediatric studies, it remains markedly lower than that in adult kidney transplant recipients . Previous studies reported a higher incidence of cancer, with a 20‐year cumulative incidence of cancer (including nonmelanoma skin cancer) approaching as high as 60% in adult transplant recipients .…”

Section: Discussioncontrasting

confidence: 63%

“…Cancer is an important and well-recognized complication after kidney transplantation in adults (1,2). The cumulative absolute risk of any cancer 20 years after transplantation is approximately 35%, corresponding to a relative increased risk of fourfold compared with the general population (3)(4)(5). The excess risk is site specific, being higher for virus-related cancers such as posttransplant lymphoproliferative disorder (PTLD) and cervical cancer and lower for non-virus-and non-immune-related cancers, such as breast and bowel cancers (6).…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood

Francis

Johnson

Craig

et al. 2017

American Journal of Transplantation

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Cancer risk is increased substantially in adult kidney transplant recipients, but the long-term risk of cancer in childhood recipients is unclear. Using the Australian and New Zealand Dialysis and Transplant Registry, the authors compared overall and site-specific incidences of cancer after transplantation in childhood recipients with population-based data by using standardized incidence ratios (SIRs). Among 1734 childhood recipients (median age 14 years, 57% male, 85% white), 289 (16.7%) developed cancer (196 nonmelanoma skin cancers, 143 nonskin cancers) over a median follow-up of 13.4 years. The 25-year cumulative incidences of any cancer were 27% (95% confidence intervals 24-30%), 20% (17-23%) for nonmelanoma skin cancer, and 14% (12-17%) for nonskin cancer (including melanoma). The SIR for nonskin cancer was 8.23 (95% CI 6.92-9.73), with the highest risk for posttransplant lymphoproliferative disease (SIR 45.80, 95% CI 32.71-62.44) and cervical cancer (29.4, 95% CI 17.5-46.5). Increasing age at transplantation (adjusted hazard ratio [aHR] per year 1.10, 95% CI 1.06-1.14), white race (aHR 3.36, 95% CI 1.61-6.79), and having a functioning transplant (aHR 2.27, 95% CI 1.47-3.71) were risk factors for cancer. Cancer risk, particularly for virus-related cancers, is increased substantially after kidney transplantation during childhood.

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood

Francis

Johnson

Craig

et al. 2017

American Journal of Transplantation

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“…Cancer is common after kidney transplantation, with cumulative incidence of cancer in primary kidney transplant recipients in excess of 60% after 20 years post-transplant [ 8 ]. Epidemiological studies have consistently shown that the incidences of multiple cancers, particularly viral- and immune-mediated cancers are significantly greater in kidney transplant recipients compared to the age- and gender-matched general population.…”

Section: Discussionmentioning

confidence: 99%

Long-term allograft and patient outcomes of kidney transplant recipients with and without incident cancer - a population cohort study

2017

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The excess risk for cancer in kidney transplant recipients is substantial, but the allograft and patient survivals after cancer development are under-studied. This is a population-based cohort study of all primary live and deceased donor kidney transplant recipients in Australia and New Zealand between 1990-2012. The risks of overall graft loss and death with a functioning graft in kidney transplant recipients with and without incident cancer were determined using adjusted Cox regression analysis, with incident cancer considered as a time-varying covariate in the models. In those with incident cancer, types and cancer stage at diagnoses were reported. Of 12,545 transplant recipients followed for a median of 6.9 years (91,380 patient-years), 1184 (9.4%) developed incident cancers at a median of 5.8 years post-transplant. Digestive, kidney and urinary tract cancers were the most common cancer types, although digestive and respiratory tract cancers were more aggressive, with 40% reported as advanced cancers at time of cancer diagnosis. Cancer-related deaths accounted for approximately 80% of recipients with a prior cancer history. Compared with recipients with no prior cancer, the adjusted hazard ratios (HR) for overall graft loss and death with functioning graft were 4.34 (95%CI 3.90, 4.82; p<0.001) and 9.53 (95%CI 8.30, 10.95; <0.001) among those with a prior cancer. Incident cancer after kidney transplantation is a significant risk factor for death with a functioning graft, with the majority of deaths attributed to cancer. A greater understanding of the barriers to screening and treatment approaches following cancer diagnosis may lead to improve survival in kidney transplant recipients with cancer.

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“…1,12 The cumulative incidence of de novo cancer (including non-melanoma skin cancer [NMSC]) at 10 years post-kidney transplantation is around 40%, increasing to 60% at 20 years. 13 Figure 1 shows the cumulative incidence of overall cancer up to 20 years post-transplant among Australian and New Zealand recipients of a first kidney transplant, with separate incidence curves for those with de novo NMSC and solid cancers.…”

Section: Incidence and Causes Of De Novo Cancer Post-kidney Transplanmentioning

confidence: 99%

“…of cancer (including NMSC) of around 60% by 20 years, around 13% to 20% of paediatric recipients will develop cancer by 20 years. 13,20,[23][24][25] Paediatric recipients are around 20 times more likely to develop non-skin cancer before the age of 25 than the age-matched general population, with a lifetime elevated risk of 6 to 8 fold. 20,24,26 Similar to adult recipients, NMSC (predominantly SCC) are the most common causes of post-transplant cancer.…”

Section: Cancer Risk In Paediatric Kidney Transplant Recipientsmentioning

confidence: 99%

Post-transplant cancer: An epidemiological evaluation

Francis

Lim

et al. 2020

Journal of Onco-Nephrology

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Kidney transplantation is a lifechanging event for patients with end-stage kidney disease (ESKD) because it improves the quality of life and survival of these patients. However, it is not a cure and is not without complications. Transplant recipients have an excess risk of premature death (largely from cancer and cardiovascular disease (CVD)) by at least 10-times compared to the general population. Published work has identified cancer as one of the most important and feared outcomes in transplant recipients and is a key research priority recognised by both patients and health professionals. There is also convincing epidemiological evidence, suggesting the overall risk of developing cancer in the transplant population is approximately 2 to 3-fold higher compared to the age-matched general population. Unlike CVD, where the death rates have fallen considerably over the past decade in this population in response to better screening, preventative and intervention approaches, the excess risk of cancer-related deaths in transplant recipients remains at least 10-fold higher compared to cancer patients in the general population. The causes of the increased risk of death are unknown but may be a consequence of possible differences in tumour biology under the influence of immunosuppression. In this review, we will discuss the epidemiology of overall and site-specific cancer risk and death across different countries. We will also focus on the current evidence on the prevention and screening in our at-risk transplant candidates. Finally, management strategies of common cancers such as skin, post-transplant lymphoproliferative disease and solid organ cancers such as colorectal, breast and lung cancer will be evaluated.

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Cancer in ESRD: Clear on the Epidemiology, Hazy on the Mechanisms

Cited by 5 publications

References 12 publications

Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood

Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood

Long-term allograft and patient outcomes of kidney transplant recipients with and without incident cancer - a population cohort study

Post-transplant cancer: An epidemiological evaluation

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