Gender differences in cancer risk after kidney transplantation

Abstract

Kidney transplant (KT) recipients are at greater risk of developing some cancers than the general population. Moreover, cancer is the only cause of death that is currently increasing after kidney transplantation. We analyzed incidence, risk factors and characteristics of post-transplant malignancies (solid organ tumors and lymphoproliferative disorders) at our center in 925 KT recipients (1979-2014). Sex differences were particularly assessed. One hundred and eight patients (11.7%) developed solid organ tumors (76.9%) or lymphoma (23.1%). Twenty-one percent of patients who reached 20 years after KT developed cancer, with a median post-KT time to diagnosis of 7.4 years. Most common solid organs affected were lung (30.1%), prostate (10.8%), bladder (9.6%), and native kidney (7.2%). When analyzing standardized incidence ratios (SIR) by gender compared to the general population, relative risk was increased in women (SIR = 1.81; 95%CI, 1.28–2.45) but not significantly increased in men (SIR = 1.22; 0.95–2.52). Regarding specific types, gynecological (SIR = 11.6; 4.2–22.7) and lung (SIR = 10.0; 4.3–18.2) in women, and bladder (SIR = 16.3; 5.9–32.1) in men were the most affected locations. Thymoglobulin, a polyclonal antibody that has been used as an immunosuppressive agent in kidney transplantation over the last decades, was a significant risk factor for developing cancer in adjusted regression analysis [IRR = 1.62, 1.02–2.57; p = 0.041], and was associated with lower patient survival. Compared with the general population, the incidence of post-KT non-skin cancer is almost two-fold higher in women but not significantly higher in men. Lung is the most common solid organ affected. Thymoglobulin induction therapy is associated with a greater risk.

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

“…Tobacco is the main risk factor, also after KT. Earlier investigations found an increased risk for lung cancer after KT, especially in females, that was not seen in the present study (Table 2) [10].…”

“…The risk varies for all malignancies and is believed to be multifactorial but possibly triggered by the chronic exposure to immunosuppressive agents [6][7][8]. With the improving long-term outcome after transplantation, de-novo malignancies have become one of the three major causes of death after transplantation while death from cardiovascular disease and infections are decreasing in frequency [9,10].…”

Cancer Risks in Solid Organ Transplant Recipients: Results from a Comprehensive Analysis of 72 Cohort Studies

“…Supplementary Table S3 provides details of the included studies, which involved e1848068-2 a total of 2,105,122 solid organ transplant recipients and reported 45 types of site-specific cancer. Of them, 52 studies 7,8,75 provided SIRs of multiple cancers of solid organ transplantations (11 for multiple organs, 7,8,[17][18][19][20][21][22][23][24][25] 19 for kidney, [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] 16 for liver, [45][46][47][48][49][50][51][52][53][54][55]75 7 for heart and/or lung [60][61][62][76]…”

Clinical applications of uterus transplantation in China: Issues to take into consideration

“…To those who suffer from AUFI, UTx endows them the legal, biological and gestational motherhood and helps to give them the possibility to experience both the physical and the emotional aspects of pregnancy. However, transplant recipients of solid organs have been documented to be at a higher risk of developing diabetes mellitus and malignancies, especially for female patients . But it is interesting that stratification based on geographical region indicated that the pooled standardized incidence rates of cancers in Asian populations of renal transplant recipients (RTR) were lower than those in non‐Asian RTR .…”

“…However, transplant recipients of solid organs have been documented to be at a higher risk of developing diabetes mellitus and malignancies, especially for female patients. [43][44][45][46] But it is interesting that stratification based on geographical region indicated that the pooled standardized incidence rates of cancers in Asian populations of renal transplant recipients (RTR) were lower than those in non-Asian RTR. 47 What is more, unlike the kidney, liver and other solid organs, the transplanted uterus can be removed after 1-2 live deliveries.…”