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

Taborelli, Martina; Serraino, Diego; Cimaglia, Claudia; Furian, Lucrezia; Biancone, Luigi; Busnach, G; Todeschini, Paola; Bossini, Nicola; Iaria, Maurizio; Campise, Mariarosaria; Veroux, Massimiliano; Citterio, Franco; Ambrosini, A; Cantaluppi, Vincenzo; Mangino, Margherita; Pisani, Francesco; Tisone, Giuseppe; Fiorentino, Marco; Argiolas, Davide; Caputo, Flavia; Piselli, Pierluca

doi:10.1111/ajt.16825

Cited by 5 publications

(3 citation statements)

References 34 publications

(80 reference statements)

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“…The risk of developing cancer is two to five times higher in individuals who received solid organ transplantation (SOT) than in the corresponding general population [1][2][3][4][5]. Furthermore, several studies have indicated that de novo cancers among SOT recipients tend to be clinically more aggressive and to have a poorer prognosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Variation in Post-Transplant Cancer Incidence among Italian Kidney Transplant Recipients over a 25-Year Period

Piselli

Serraino

Cimaglia

et al. 2023

Cancers

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This cohort study examined 25-year variations in cancer incidence among 11,418 Italian recipients of kidney transplantation (KT) from 17 Italian centers. Cancer incidence was examined over three periods (1997‒2004; 2005‒2012; and 2013‒2021) by internal (Incidence rate ratio-IRR) and external (standardized incidence ratios-SIR) comparisons. Poisson regression was used to assess trends. Overall, 1646 post-transplant cancers were diagnosed, with incidence rates/1000 person-years ranging from 15.5 in 1997–2004 to 21.0 in 2013–2021. Adjusted IRRs showed a significant reduction in incidence rates across periods for all cancers combined after exclusion of nonmelanoma skin cancers (IRR = 0.90, 95% confidence interval-CI: 0.76–1.07 in 2005‒2012; IRR = 0.72, 95% CI: 0.60–0.87 in 2013‒2021 vs. 1997‒2004; Ptrend < 0.01). In site-specific analyses, however, significant changes in incidence rates were observed only for Kaposi’s sarcoma (KS; IRR = 0.37, 95% CI: 0.24–0.57 in 2005‒2012; IRR = 0.09, 95% CI: 0.04–0.18 in 2013–2021; Ptrend < 0.01). As compared to the general population, the overall post-transplant cancer risk in KT recipients was elevated, with a decreasing magnitude over time (SIR = 2.54, 95% CI: 2.26–2.85 in 1997‒2004; SIR = 1.99, 95% CI: 1.83–2.16 in 2013‒2021; Ptrend < 0.01). A decline in SIRs was observed specifically for non-Hodgkin lymphoma and KS, though only the KS trend retained statistical significance after adjustment. In conclusion, apart from KS, no changes in the incidence of other cancers over time were observed among Italian KT recipients.

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Section: Introductionmentioning

confidence: 99%

Variation in Post-Transplant Cancer Incidence among Italian Kidney Transplant Recipients over a 25-Year Period

Piselli

Serraino

Cimaglia

et al. 2023

Cancers

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“…All our patients received treatment with cyclophosphamide before transplantation, with a mean cumulative dose of 9.9 g. It is well known that kidney transplanted patients are at increased risk of developing cancer compared with the general population because of continuous immunosuppressive therapy [14,15]. This concept is also applicable to patients with AAV.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation in patients with ANCA-associated vasculitis is associated with a high incidence of post-transplant cancer

Perna,

Campise,

Alfieri

et al. 2024

J Nephrol

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Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease with limited data on outcomes after transplantation. Methods In this single-center retrospective cohort study, we describe the outcomes of kidney transplant patients with AAV transplanted at our institute from February 2006 to January 2022. Results We identified 9 patients among 1026 with a pre-transplant diagnosis of AAV; all patients had received previous treatment with cyclophosphamide. Maintenance immunosuppression after transplantation was tacrolimus-based in 89% of the patients. At the end of a mean follow-up of 132 ± 61.1 months after transplantation, only one case of extrarenal vasculitis relapse was observed. The relapse rate was 0.01 per patient per year, which is comparable to that reported in the literature. However, seven patients were diagnosed with cancer after a mean follow-up of 81.4 months after transplantation; six had skin cancer and three had renal cell carcinoma (RCC) of the native kidneys (cumulative incidence of 78%). One patient died from metastatic squamous cell carcinoma. Conclusion In this study, we found a noticeable decrease in disease relapse (1 relapse in the present cohort vs 7 relapses in 19 patients in the previous cohort) in kidney transplant patients with AAV compared with previous data from our group (December 1987–January 2006). Conversely, we found a high incidence of post-transplant cancer. This result could be attributed to reduced immunosurveillance due to immunosuppression therapy before and after transplantation. Therefore, constant cancer early diagnosis and prevention is mandatory during the post-transplant follow-up of AAV patients. Graphical abstract

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“…1,2 While trends in mortality from cardiovascular disease and infections in the transplant population shows declines due to a combination of improved therapies and preventive strategies, 3,4 cancer is expected to become the leading cause of death. Transplant recipients who have developed post-transplant cancer have been shown to have a higher risk of death with a functioning graft than recipients without cancer, 5,6 with most deaths attributed to cancer. 7 However, cancer as a cause of death in transplant recipients have not yet been fully elucidated in comparison with the general population.…”

Section: Introductionmentioning

confidence: 99%

Cancer mortality after kidney transplantation: A multicenter cohort study in Italy

Taborelli,

Serraino,

Cimaglia

et al. 2023

Intl Journal of Cancer

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Kidney transplant (KT) recipients are known to be at risk of developing several cancer types; however, cancer mortality in this population is underinvestigated. Our study aimed to assess the risk of cancer death among Italian KT recipients compared to the corresponding general population. A cohort study was conducted among 7373 individuals who underwent KT between 2003 and 2020 in 17 Italian centers. Date and cause of death were retrieved until 31 December 2020. Indirect standardization was used to estimate standardized mortality ratios (SMRs) and corresponding 95% confidence intervals (CIs). Cancer was the most common cause of death among the 7373 KT recipients, constituting 32.4% of all deaths. A 1.8‐fold excess mortality (95% CI: 1.59‐2.09) was observed for all cancers combined. Lymphomas (SMR = 6.17, 95% CI: 3.81‐9.25), kidney cancer (SMR = 5.44, 95% CI: 2.97‐8.88) and skin melanoma (SMR = 3.19, 95% CI: 1.03‐6.98) showed the highest excess death risks. In addition, SMRs were increased about 1.6 to 3.0 times for cancers of lung, breast, bladder and other hematopoietic and lymphoid tissues. As compared to the general population, relative cancer mortality risk remained significantly elevated in all age groups though it decreased with increasing age. A linear temporal increase in SMR over time was documented for all cancers combined (P < .01). Our study documented significantly higher risks of cancer death in KT recipients than in the corresponding general population. Such results support further investigation into the prevention and early detection of cancer in KT recipients.

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

Cited by 5 publications

References 34 publications

Variation in Post-Transplant Cancer Incidence among Italian Kidney Transplant Recipients over a 25-Year Period

Variation in Post-Transplant Cancer Incidence among Italian Kidney Transplant Recipients over a 25-Year Period

Kidney transplantation in patients with ANCA-associated vasculitis is associated with a high incidence of post-transplant cancer

Cancer mortality after kidney transplantation: A multicenter cohort study in Italy

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