Comparison of De Novo Cancer Incidence in Australian Liver, Heart and Lung Transplant Recipients

Abstract

Population-based evidence on the relative risk of de novo cancer in liver and cardiothoracic transplant recipients is limited. A cohort study was conducted in Australia using population-based liver (n = 1926) and cardiothoracic (n = 2718) registries (1984-2006). Standardized incidence ratios (SIRs) were computed by cancer type, transplanted organ and recipient age. Cox regression models were used to compare cancer incidence by transplanted organ. During a median 5-year follow-up, the risk of any cancer in liver and cardiothoracic recipients was significantly elevated compared to the general population (n = 499; SIR = 2.62, 95%CI 2.40-2.86). An excess risk was observed for 16 cancer types, predominantly cancers with a viral etiology. The pattern of risk by cancer type was broadly similar for heart, lung and liver recipients, except for Merkel cell carcinoma (cardiothoracic only). Seventeen cancers (10 non-Hodgkin lymphomas), were observed in 415 pediatric recipients (SIR = 23.8, 95%CI 13.8-38.0). The adjusted hazard ratio for any cancer in all recipients was higher in heart compared to liver (1.29, 95%CI 1.03-1.63) and lung compared to liver (1.65, 95%CI 1.26-2.16). Understanding the factors responsible for the higher cancer incidence in cardiothoracic compared to liver recipients has the potential to lead to targeted cancer prevention strategies in this high-risk population.

Cancer in the Transplant Recipient

“…Registry data from around the world has established that the pattern of increase in risk for cancer at different sites is seen consistently (Kyllönen et al 2000;Adami et al 2003;Vajdic et al 2006;Villeneuve et al 2007;Collett et al 2010;Jiang et al 2010;Engels et al 2011;Na et al 2013 Skin cancers, specifically basal cell and squamous cell skin cancers, are common after transplantation, and incidence increases with time. Australian estimates in kidney recipients found 50% experienced at least one skin cancer by 10 years and 80% by 20 years after transplantation (Ramsay et al 2002).…”

“…Variation in Cancer Risk According to Transplanted Organ Table 5 summarizes the published standardized incidence ratios (SIR) for several different cancer sites, stratified by transplanted organ, taken from national population-based studies (Kyllö-nen et al 2000;Adami et al 2003;Vajdic et al 2006;Villeneuve et al 2007;Collett et al 2010;Jiang et al 2010;Engels et al 2011;Na et al 2013). SIR can be interpreted as relative risk, as they estimate risk for organ recipients relative to the cancer incidence experienced by the general population, after allowing for differences in age, sex, and year of diagnosis.…”

Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey

“…In our study, two patients were diagnosed with Kaposi's sarcoma and both were HHV-8 positive. One of the most important adverse effects of immunosuppression in all solid organ transplant recipients is an increased risk of solid organ malignancy (30,31). We detected solid organ tumors in 46.2% of our patients with malignancy.…”

De novo malignancy after lung transplantation in Japan

“…In general, overall cancer incidence in the solid organ transplant population is threefold to fivefold higher than in the general population [2,3] due to the influence of longterm immunosuppression and several oncogenic viral infections. Immunosuppression for LTx needs to be more aggressive because of its strong immunogenicity.…”