Cancer risk and mortality after solid organ transplantation: A population‐based 30‐year cohort study in Finland

Friman, Terhi; Jäämaa‐Holmberg, Salla; Åberg, Fredrik; Helanterä, Ilkka; Halme, Maija; Pentikäinen, Markku O.; Nordin, Arno; Lemström, Karl; Jahnukainen, Timo; Räty, Riikka; Salmela, Birgitta

doi:10.1002/ijc.33934

Cited by 36 publications

(45 citation statements)

References 55 publications

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“…For example, skin cancer was the most common malignancy diagnosed after SOT in our cohort, followed by lymphoma and kidney cancer. 35 In concordance with the largest study of cancer risk in SOT recipients, our data demonstrated that the majority of liver cancer diagnoses occur within the first year of transplantation and kidney cancer incidence was highest in kidney transplant recipients. 5 A recent population-based cohort study in Finland found increased incidence of cancer rates in heart and lung transplant recipients in comparison to kidney and liver transplant recipients.…”

Section: Discussionsupporting

confidence: 89%

“…5 A recent population-based cohort study in Finland found increased incidence of cancer rates in heart and lung transplant recipients in comparison to kidney and liver transplant recipients. 35 However, upon adjusting for immunosuppressive medications, we found no difference in the rates of malignancy between SOT groups, indicating the increased risk may be due to the medication. In liver transplant recipients, cumulative exposure to tacrolimus increased the risk of cancer.…”

Section: Discussionmentioning

confidence: 64%

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Multicenter analysis of immunosuppressive medications on the subsequent risk of malignancy in solid organ transplant recipients

Shaw

Haque

Fitzsimons

et al. 2022

Preprint

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Solid organ transplant is a curative treatment for end organ disease. However, the immunosuppressive therapy required to prevent graft rejection increases the likelihood of developing a subsequent malignancy. This retrospective cohort study from a multi-center academic hospital system investigated solid organ transplantation, immunosuppression, and the risk of subsequent malignancy. Of the 5,591 patients and 6,142 transplanted organs studied, there were 517 subsequent malignancies identified. Skin cancer was the most common type of malignancy to be diagnosed, whereas liver cancer was the first malignancy to present at a median time of one-year post-transplant. Subsequent malignancy was proportionally more often diagnosed in non-Hispanic White transplant recipients compared to other racial groups. Heart and lung transplant recipients had relatively higher rates of subsequent malignancy than liver and kidney transplant recipients, but this finding was not significant upon adjusting for immunosuppressive medications. Multivariate cox proportional hazard analysis and random forest variable importance calculations identified statistically significant correlations with sirolimus and azathioprine and high rates of malignancy after transplant, while tacrolimus was associated with low rates of post-transplant neoplasia.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 64%

Multicenter analysis of immunosuppressive medications on the subsequent risk of malignancy in solid organ transplant recipients

Shaw

Haque

Fitzsimons

et al. 2022

Preprint

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“…Young patients who undergo solid‐organ transplantation (SOT) have decreased life expectancy when compared to the general population due to post‐transplantation complications such as acute or chronic graft rejection, infection, and death from malignancy. 6 , 7 There is a nearly 9% risk of developing a noncutaneous nonlymphomatous malignancy at 5 years, and for all malignancies, there is a 30% incidence rate at 10 years of post‐SOT. 8 , 9 Therefore, early detection and screening in post‐transplant patients is imperative to improve long‐term mortality.…”

Section: Discussionmentioning

confidence: 99%

Rapidly progressive pulmonary hypertension and right ventricular failure in a heart and kidney transplant recipient

Deicke

Alhuneafat

Obaid

et al. 2022

Clinical Case Reports

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A 54‐year‐old man status post heart and kidney transplant presented with dyspnea. Imaging was consistent with lymphangitic carcinomatosis (LC), in the setting of biopsy proven adenocarcinoma. He developed pulmonary hypertension (PH) and died of right ventricular failure (RVF) 3 weeks later. Acute PH with radiographic features of LC in a high‐risk patient warrants expedited malignancy investigation.

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“…Immunosuppression is a risk factor for melanoma, BCC and SCC. Populations with compromised immunity at increased risk include organ transplant recipients [ 118 ], those diagnosed with HIV/AIDS (fourfold increased risk of melanoma) [ 119 , 120 ], and those treated for rheumatoid arthritis (~ 1.3-fold increased risk of KC and melanoma) [ 121 ], inflammatory bowel disease (~ 1.5-fold increased risk of KC), and some lymphoproliferative disorders including non-Hodgkin lymphoma and chronic lymphocytic leukaemia (~ twofold increased risk of melanoma) [ 122 ]. In solid-organ transplant recipients the magnitude of the increased risk differs between skin cancer types: the increased risk in a high ambient UV radiation environment is two–threefold for melanoma, six–tenfold for BCC, and as high as 100-fold for SCC [ 123 ].…”

Section: Harms Of Exposure To Uv Radiationmentioning

confidence: 99%

The effects of exposure to solar radiation on human health

Neale

Lucas

Byrne

et al. 2023

Photochem Photobiol Sci

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This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors. Graphical abstract

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Cancer risk and mortality after solid organ transplantation: A population‐based 30‐year cohort study in Finland

Cited by 36 publications

References 55 publications

Multicenter analysis of immunosuppressive medications on the subsequent risk of malignancy in solid organ transplant recipients

Multicenter analysis of immunosuppressive medications on the subsequent risk of malignancy in solid organ transplant recipients

Rapidly progressive pulmonary hypertension and right ventricular failure in a heart and kidney transplant recipient

The effects of exposure to solar radiation on human health

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