Overall and Site-Specific Cancer Mortality in Patients on Dialysis and after Kidney Transplant

Abstract

Background Patients with ESRD have a substantially increased cancer risk, but few studies have examined the patterns of cancer mortality along a patient's journey from dialysis to transplantation. MethodsWe identified all Australian patients on dialysis and patients with transplants from 1980 to 2014 from the Australia and New Zealand Dialysis and Transplant Registry. Using standardized mortality ratios (SMRs), we compared cancer mortality among patients on dialysis and patients with transplants versus the general population (overall and by age, sex, year, and site); we also performed a subgroup analysis excluding patients with preexisting cancers. ResultsWe followed 52,936 patients on dialysis and 16,820 transplant recipients for 170,055 and 128,352 patient-years, respectively. There were 2739 cancer deaths among patients on dialysis and 923 cancer deaths among transplant recipients. Overall, cancer SMRs were 2.6 for patients on dialysis and 2.7 for transplant recipients. For patients on dialysis, SMRs were highest for multiple myeloma (30.5), testicular cancer (17.0), and kidney cancer (12.5); for transplant recipients, SMRs were highest for non-Hodgkin lymphoma (10.7), kidney cancer (7.8), and melanoma (5.8). Some 61.0% of patients on dialysis and 9.6% of transplant recipients who experienced cancer death had preexisting cancer. The SMRs for de novo cancer was 1.2 for patients on dialysis and 2.6 for transplant recipients.Conclusions Patients on dialysis and transplant recipients experienced .2.5-fold increased risk of cancer death compared with the general population. This increased risk was largely driven by preexisting cancers in patients on dialysis and de novo cancers in patients with transplants.

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population‐based cohort study, 1980–2013

“…Our study builds upon prior estimates of cancer mortality in transplant recipients with long‐term follow‐up, which found all‐site cancer and malignant nontransplant related cancer mortality risk was similarly increased over the general population (SMR 2–3) and highest in the young . However, we found this is not true for all cancer types.…”

“…Incident nonmelanoma skin cancers are nonnotifiable, making population‐based estimates of cancer incidence difficult. Previous Australian studies attribute the highest excess mortality to viral related cancers including posttransplant lymphoproliferative but were unable to capture nonmelanoma skin cancer death . Here we provide population‐based estimates of the nonmelanoma skin cancer mortality burden in kidney transplant recipients in Australia and New Zealand based on population data.…”

“…Estimates from the USA and Canada have described contradictory results; risk of death was not increased in USA transplant recipients but was three times higher than the general population in Canada . Relying solely on unverified transplant registry information, without death register information, mortality risk was 2.7 times higher than the general population in Australia . Verification of cause of death using data‐linkage to death registry data would provide a more reliable estimate of cancer mortality in transplant recipients and may highlight different trends.…”

Briefly Noted

“…The study examined 52,936 dialysis patients and 16,820 transplant patients in Australia for 1980 -2014. 12 The likelihood of a HD patient being readmitted to the hospital within 30 days after discharge from the hospital was high and was a function of the number of hospitalizations in the previous year. The adjusted risks of rehospitalization were 19%, 23%, and 31% for 0-1, 2-4, and >4 prior hospitalizations, respectively, for an unrelated diagnosis and 7%, 10%, and 15%, respectively, for a related diagnosis.…”

“…In most (61%) cancer deaths in dialysis patients, the cancer was pre‐existing unlike that in transplant patients (9.6%). The study examined 52,936 dialysis patients and 16,820 transplant patients in Australia for 1980 – 2014 …”