De Novo Cancer Incidence after Kidney Transplantation in South Korea from 2002 to 2017

Abstract

Advances in patient care and immunosuppressive drugs have improved graft survival, resulting in an increase in kidney transplantation (KT); however, persistent immunosuppression is thought to cause late occurrence of cancer. This population-based study consisted of a total of 14,842 patients whose data from the years 2002 to 2017 were collected from the National Health Information Database in South Korea. Malignancies occurred in 7.6% of the total KT patients. Prostate and thyroid cancers were the most common in males and females, respectively. From the age-adjusted incidence analysis, Kaposi’s sarcoma showed the highest standardized incidence ratio in both male and female patients. According to the linear regression model, cancer incidence in KT recipients under immunosuppressive conditions increased by approximately 0.1% each month. Patients’ age over 39 and the use of prednisolone as an initial steroid regimen were associated with increased risk of cancer development after KT. Our regression and proportional hazards models will help clinicians to predict the approximate cancer incidence risk when monitoring KT recipients. Based on the largest available national database, screening or monitoring methods for cancer detection and prevention can be established for KT patients by considering the factors involved in cancer development.

Graft lymphoma in a kidney transplant recipient: a case report

“…In a population-based nationwide study conducted in South Korea, it was found that approximately 7% of all kidney transplant recipients developed cancer. The incidence of PTLDs, including Kaposi's sarcoma and non-Hodgkin lymphoma, was higher than in the general population when considering the standardized incidence ratio [ 4 ].…”

Associations of Perioperative Red Blood Cell Transfusion With Outcomes of Kidney Transplantation in Korea Over a 16-Year Period

“… 3 4 The reported percentage of KT patients receiving post-transplant transfusion has ranged from 28.0% to 37.2% in Canada and France, 15 21 and 49.7% of KT recipients received RBC transfusion during the perioperative period in Korea. 19 When we excluded patients who received transfusions of two or more types of RBCs, 48.0% of 17,754 KT recipients received RBC transfusion during the perioperative period between 2002 and 2017.…”

“…Generally, in order to reduce the risk of allosensitization, leuko-reduced RBCs are preferable for KT recipients 9 ; however, in practice, several additional types of RBC preparations including pRBCs, filtered RBCs, and washed RBCs have been transfused into Korean patients. 19 Of the 8,530 patients who received RBC transfusion, 74.9% received filtered RBCs, 19.7% received pRBCs, and 5.4% received washed RBCs. Among the 77 institutions included in this study, 64 and/or 27 respectively used pRBCs and/or washed RBCs ( Table 2 ).…”

“…Graft failure was defined as a KT recipient undergoing repeated dialysis for three months or longer during the post-KT follow-up period. 19 The Organ Transplantation Act of South Korea requires a recipient to pay for the cost of donor nephrectomy in the case of living-donor KT, while the government covers the primary cost for organ donation in the case of a deceased donor. Therefore, the donor type was able to be classified as a living donor when the EDI code for donor nephrectomy ‘R3272’ was charged to a recipient.…”

“…The codes or criteria for defining variables in building a database have been described in previous studies. 19 20 Because death certificates are automatically reported to the KNHIS, mortality was detected when healthcare coverage by the KNHIS was terminated.…”