Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008—A Swedish population‐based study

Abstract

Organ transplant recipients are at increased risk of a wide range of malignancies, especially cutaneous squamous cell carcinomas (SCC). Few previous population-based studies have quantified and compared cancer risks according to graft type and with long-term follow-up. Using nationwide Swedish registers, we identified 10,476 recipients transplanted from 1970 to 2008 and followed them for cancer occurrence. Relative risks of cancer in comparison with the general population were expressed as standardized incidence ratios (SIR) and within the transplanted cohort as incidence rate ratios (IRR). During a total follow-up of 93,432 person-years, patients were diagnosed with 1,175 cancers excluding SCC, and with 2,231 SCC, SIR cancer excl SCC 2.4 (95% CI, 2.2-2.5); SIR SCC 121 (95% CI, 116-127). Cancer risks were most increased among heart and/or lung recipients SIR cancer excl SCC 3.3 (95% CI, 2.8-4.0); SIR SCC 198 (95% CI, 174-224), followed by kidney SIR cancer excl SCC 2.3 (95% CI, 2.1-2.4); SIR SCC 121 (95% CI, 116-127) and liver recipients SIR cancer excl SCC 2.3 (95% CI, 1.9-2.8); SIR SCC 32 (95% CI, 24-42). During follow-up, risk of cancer excluding SCC remained stable while risk of SCC tripled over 20 years irrespective of graft type, partly due to a subgroup of patients developing new SCCs at a rapidly increasing rate. In summary, posttransplant cancer risk varied by transplanted organ and by cancer site, with the bulk of the excess risk driven by an exceptionally high and accelerating risk of SCC. These findings underscore the importance of regular skin screening in organ transplant recipients.

Significantly higher incidence of skin cancer than other malignancies in patients after heart transplantation. A retrospective cohort study in the Czech Republic

“…In our cohort it was not possible to assess its association due to incomplete data. Similarly, higher incidence of PTLD has been observed in some recent studies 5,6 . There are still only a few data in the literature evaluating other types of malignancies in HTRs.…”

“…Most of the available data show elevated risk of malignancy in organ transplant recipients 5,6 . In our study, we analysed the demographic characteristics, frequency and histopathological spectrum of tumours in 603 patients after HT.…”

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

“…Of these, 39 were excluded, as they comprised 3 duplicate studies, 2 studies not written in English, 1 review, 21 from which the SIR and 95% CI could not be calculated, 10 studies on hospital-based cohorts and 2 on irrelevant topics. Finally, 22 cohort studies contained in 18 studies were included in the present meta-analysis (8)(9)(10)(11)(12)(13)(14)(15)(16)(22)(23)(24)(25)(26)(27)(28)(29)(30). The main characteristics of the studies included are presented in Table I.…”

“…However, the distribution of cancer types in Asian RTRs differed from that in non-Asian RTRs. Numerous studies have shown that in Western countries, RTRs are at greater risk of developing NMSC (16,25,26). By contrast, NHL as well as renal and bladder cancer had the highest SIRs in Hong Kong (14), and kidney cancer was the most common cancer type in Taiwan (13) and Japan (24).…”

“…In the past few years, several studies using registry data have provided convincing evidence for the increased incidence of certain cancer types in patients receiving RRT (4,(8)(9)(10)(11)(12)(13)(14)(15)(16). However, it remains to be determined whether meta-analysis of these studies and others may provide results that are different from those of previous meta-analyses.…”