Malignancy-related mortality following kidney transplantation is common

Abstract

There is a paucity of studies describing malignancy-related mortality after kidney transplantation. To help quantify this, we extracted data for all kidney-alone transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed between Hospital Episode Statistics and the Office for National Statistics to identify all deaths occurring in this cohort. Among 19,103 kidney transplant procedures analyzed (median follow-up 4.4 years), 2085 deaths occurred, of which 376 (18.0%) were due to malignancy (crude mortality rate 361 malignancy-related deaths per 100,000 person-years). Common sites of malignancy-related death were lymphoma (18.4%), followed by lung (17.6%) and renal (9.8%), with 14.1% unspecified. The risk of malignancy-related death increased with age: under 50 (0.8%), 50-59 (2.5%), 60-69 (4.8%), 70-79 (6.5%) and over 80 years (9.1%). Age- and gender-stratified malignancy-related mortality risk difference was higher in the transplant compared with the general population. Cox proportional hazard models identified increased age, pretransplant history of malignancy and deceased-donor kidney transplantation to be independently associated with risk for post-transplant death from malignancy. Thus, malignancy as a cause of post-kidney transplantation death is common and requires heightened surveillance.

Mortality risk after cancer diagnosis in kidney transplant recipients: the limitations of analyzing hospital administration data alone

“…From a HES perspective, our analysis of the cancer incidence ratio is skewed against cancers not likely to lead to a hospitalization episode (i.e., nonmelanoma skin cancers which are the most commonly occurring cancers after kidney transplantation). We therefore opted to omit all nonmelanoma skin cancer from our analysis as they are least likely to cause death 5, 6, 13 and will have little impact upon our mortality observations. The hospitalized general population cohort could have a greater burden of health comorbidities that has skewed comparisons with kidney transplant recipients, leading to the paradoxical survival outcomes for the latter.…”

“…One of the major complications after kidney transplantation is the development of cancer, and the similarity of (infection‐related) cancer development between kidney allograft recipients and patients with HIV/AIDS suggesting immune deficiency, rather than other risk factors, contributes to increased cancer rates after kidney transplantation 2. Cancer is one of the greatest concerns for kidney allograft recipients themselves 3, is associated with increased cost 4, and is linked to increased incidence and mortality in population cohort studies 5, 6, 7, 8, 9, 10, 11, 12, 13. This makes it imperative to understand cancer development, and its risk for progression, if we are to improve long‐term outcomes after kidney transplantation.…”

High Posttransplant Cancer Incidence in Renal Transplanted Patients With Pretransplant Cancer

“…Cancer-induced mortality appears more common in the renal transplanted population than in the general population in Asia and Europe 26,27 but not in the United States. 28 Death due to cancer occurs in 18% to 27% of renal transplanted patients.…”

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“…A pretransplant history of stroke has previously been identified as one of the strongest independent risk factors for malignancy-related mortality after a kidney transplant. 20 This may reflect shared risk factors, such as smoking, which we were unable to account for in our analysis. Evidence to support this hypothesis in this study was the trend toward more lung cancer deaths in the kidney allograft cohort with pretransplant strokes, acknowledging smoking to be one the strongest risk factors for both.…”