Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period

Blosser, Christopher D.; Haber, Gregory B.; Engels, Eric A.

doi:10.1016/j.kint.2020.10.018

Cited by 27 publications

(25 citation statements)

References 46 publications

(55 reference statements)

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“…An Australian study 15 has shown that only 41% of KT recipients who developed cancer survived with a functioning graft 10 years after diagnosis. Moreover, a recent study from the United States evidenced that the absolute risk of death with a functioning graft after cancer was 38% for the most recent KT recipients transplanted in 2007–2016 12 . Although the prognosis of KT recipients with cancer varies according to the type and severity of cancer at presentation, available epidemiologic evidence has suggested that it is much worse than in non‐transplanted patients with the same cancer 8–11 .…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic impact of cancer has been investigated, in KT recipients, to a lesser extent than their risk of cancer, which is increased up to fourfold for all cancers and up to 100‐fold for virus‐associated malignancies such as non‐Hodgkin's lymphoma (NHL) or Kaposi's sarcoma 4–7 . Some studies on cancer outcomes in KT recipients highlighted a consistently worse prognosis than that observed among non‐transplant patients with the same cancer 8–12 13 …”

Section: Introductionmentioning

confidence: 99%

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The impact of cancer on the risk of death with a functioning graft of Italian kidney transplant recipients

Taborelli

Serraino

Cimaglia

et al. 2022

American Journal of Transplantation

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This study assessed the impact of cancer on the risk of death with a functioning graft of kidney transplant (KT) recipients, as compared to corresponding recipients without cancer. A matched cohort study was conducted using data from a cohort of 13 245 individuals who had undergone KT in 17 Italian centers (1997–2017). Cases were defined as subjects diagnosed with any cancer after KT. For each case, two controls matched by gender, age, and year at KT were randomly selected from cohort members who were cancer‐free at the time of diagnosis of the index case. Overall, 292 (20.5%) deaths with a functioning graft were recorded among 1425 cases and 238 (8.4%) among 2850 controls. KT recipients with cancer had a greater risk of death with a functioning graft (hazard ratio, HR = 3.31) than their respective controls. This pattern was consistent over a broad range of cancer types, including non‐Hodgkin lymphoma (HR = 33.09), lung (HR = 20.51), breast (HR = 8.80), colon‐rectum (HR = 3.51), and kidney (HR = 2.38). The survival gap was observed throughout the entire follow‐up period, though the effect was more marked within 1 year from cancer diagnosis. These results call for close posttransplant surveillance to detect cancers at earlier stages when treatments are more effective in improving survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of cancer on the risk of death with a functioning graft of Italian kidney transplant recipients

Taborelli

Serraino

Cimaglia

et al. 2022

American Journal of Transplantation

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“…The ever-widening disparity between supply and demand for transplantable grafts has led to ongoing discussions about when PTM patients should be considered eligible for RTx. Analyzing data from the US transplant registry over a 30 year period, Blosser et al could not find changes in cancer-associated mortality in RTx-recipients despite advances in both immunosuppressive, but also cancer therapy, yet without including patients with a PTM history [ 12 ]. Brattström et al recommend an adaption of waiting times to tumor aggressiveness in RTx-recipients as they identified an increased rate of cancer-associated death in PTM patients, especially in the first five years after diagnosis of cancer [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This number is even expected to increase with the expansion of the eligibility criteria for older patients. Further, among RTx-recipients cancer is the second most common cause of death and assumed to be the leading cause of death in this decade [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Tumor Recurrence and Graft Survival in Renal Transplant Recipients with a History of Pretransplant Malignancy: A Matched Pair Analysis

Becker

Mehdorn

Getsopulos

et al. 2021

JCM

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Organ scarcity demands critical decision-making regarding eligible transplant candidates and graft allocation to ensure best benefit from renal transplantation (RTx). Among the controversial relative contraindications is a history of pretransplant malignancy (PTM). While oncological outcomes of PTM-RTx recipients are well described, data on graft-specific outcome are scarce. A retrospective double case control matched pair analysis (60 months follow-up) was carried out and RTx-recipients were stratified for history of PTM. First, PTM-RTx recipients were matched according to age, sex and duration of immunosuppressive therapy. Next, PTM-RTx recipients were matched 1:1 for age, sex and cause of end-stage renal disease. Five-year patient and graft survival as well as oncological outcomes were analyzed. A total of 65 PTM-RTx recipients were identified. Post-RTx recurrence rate was 5%, while 20% developed second de novo malignancy, comparable to 14% in the control group. PTM-RTx recipients had a noticeable lower five-year death-censored as well as overall graft survival and Cox proportional hazard modeling showed a correlation between PTM and inferior graft survival. Although underlying reasons remain not fully understood, this study is the first to show inferior graft survival in PTM-RTx recipients and advocates necessity to focus on more meticulous graft monitoring in PTM recipients in addition to heightened surveillance for cancer recurrence.

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“…Prostate cancer (PCa) is the second most diagnosed cancer in men and the most common non-skin solid neoplasm in RTRs ( 9 , 10 ). Nevertheless, the real incidence of PCa in RTR remains controversial; in fact, on one hand RTRs are screened less frequently following transplantation than men in the general population, so that some cancers are missed, on the other immunosuppressive therapy (including azathioprine and calcineurin inhibitors) are associated with an increased risk of cancer and enhanced in vitro and in vivo PCa aggressiveness ( 11 , 12 ). Generally, the vast majority of post kidney transplantation prostate cancers are localized; however, due to the lack of randomized studies, no specific guidelines for the management of localized prostate cancer are available and, consequently, RTR patients are being treated with surgery or radiotherapy according to national or local guidelines ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Prostate Cancer Characteristics in Renal Transplant Recipients: A 25-Year Experience From a Single Centre

et al. 2021

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Objectives: The incidence of prostate cancer in renal transplant recipients (RTRs) is increasing, but few data are available in the literature. In this study, we reviewed the 25-year experience in the management of prostate cancer after kidney transplantation at the Florence Transplant Centre.Methods: We retrospectively reviewed the data from 617 RTR male patients who underwent renal transplantation at our institute between July 1996 and September 2016. Data regarding demographics, renal transplantation, prostate cancer and immunosuppressive treatment were analyzed. The probability of death was estimated by using the Kaplan-Meier method and differences between patients' groups were assessed by the log-rank test.Results: From July 1991 to September 2016, 617 kidney transplantations of male patients were performed at our institute. Among these, 20 patients were subsequently diagnosed with prostate cancer accounting for a cumulative incidence of 3.24%. After a median follow-up of 59 months, 10 patients underwent radical prostatectomy whereas 10 patients underwent primary radiotherapy. A biochemical recurrence was identified in five (25%) patients while a fatal event occurred in 11 (55%) patients. Univariate Cox regression showed that the basal value of PSA >10 ng/ml was the only significant factor negatively affecting the survival of patients.Conclusions: Standard treatments can be proposed to RTR with satisfactory results on both post-operative and oncological outcomes. Further studies are needed to address the issue of prostate cancer screening based on PSA levels and the optimal management of prostate cancer in RTRs.

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Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period

Cited by 27 publications

References 46 publications

The impact of cancer on the risk of death with a functioning graft of Italian kidney transplant recipients

The impact of cancer on the risk of death with a functioning graft of Italian kidney transplant recipients

Tumor Recurrence and Graft Survival in Renal Transplant Recipients with a History of Pretransplant Malignancy: A Matched Pair Analysis

Prostate Cancer Characteristics in Renal Transplant Recipients: A 25-Year Experience From a Single Centre

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