De-novo malignancies after kidney transplantation: A long-term observational study

Abstract

Background De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. Methods This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies. Results 1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation. Conclusion De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.

Post-Transplant Malignancies following Pancreas Transplantation: Incidence and Implications on Long-Term Outcome from a Single-Center Perspective

“…However, most of these studies compare cancer mortality in SOTRs with the general population and thus are not comparable to our analysis where hazard of death was compared in SOTRs with and without PTMs. Fröhlich et al recently presented data comparing patient survival in patients with and without PTMs after kidney transplantation, similar to our analysis [50]. The authors found a significantly worse survival in the malignancy group.…”

[Retracted] Current Status of Malignant Tumors after Organ Transplantation

“…Among the seven articles, Tsai et al [7] from Taiwan, China, have reported the highest morbidity which is up to 18.8%, among which the incidence of urinary system tumor was the highest, reaching 54.3%, followed by the case data reported by Apel et al [8] from Germany, of which the incidence of tumor was 12.3%, among which the incidence of gastrointestinal tumor was the highest, reaching 18.6%. Fröhlich et al [9] reported that the incidence of tumor was 10.7% in the study of the UK, and the incidence of renal cancer was the highest among the reported cases, which was 31.8%. The article did not include patients with nonmelanic skin cancer.…”

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

“…Accordingly, the Scientific Registry of Transplant Recipients analysis highlighted that lung cancer was more likely to be diagnosed at an advanced stage in KT recipients than in the general population 26 . Previous studies have observed that the prognosis of KT recipients diagnosed with colorectal cancer and breast cancer is much worse than in patients with transplant or just cancer, 8,17,27–29 whereas mixed results emerged for bladder and kidney cancers 8,17 …”

“…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 . On the other hand, limited data have been accumulated to assess whether the onset of cancer after KT carries a poor prognosis even when compared with other cancer‐free KT recipients 15–17 …”

“…They thus represent an exceptional comparison group to assess the impact of cancer on survival in KT recipients who developed a malignancy. However, only few studies have carried out internal comparisons, that is, comparing the survival of KT recipients who developed cancer with that of corresponding KT recipients without cancer 15–17 . Furthermore, none of these investigations have quantified the gap in the risks of death with a functioning graft for a broad range of cancer types.…”