Rates of both solid organ and skin cancers after kidney transplantation are substantially increased. However, little is known about the relationship between non-melanoma skin cancer (NMSC) and risk of subsequent immunosuppression.
Using the ANZDATA Registry, we looked at the incidence of solid-organ cancer after kidney transplants performed in Australia or New Zealand from 1975-2011. The Registry records the occurrence of all solid organ malignancies and the first episode of NMSC after transplantation. The occurrence of NMSC post transplantation was used as a time-dependent covariate, and risk of solid organ cancer compared among recipients. Patients were followed from the date of first transplant until death or 31 Dec 2011. In a supplementary analysis, followup was censored at the point of failure of the first graft (and therefore presumed withdrawal of immunosuppression).
The analysis included a total of 18031 transplants, with 139895 person years of followup prior to first NMSC, and 31459 person-years of followup after a first NMSC. The overall rate of development of solid organ cancer was 1.36 [95% CI 1.30-1.41] per 100 person years, higher among older people, females, and among recipients of deceased donor transplants. The crude hazard ratio for the occurrence of a solid organ malignancy after NMSC was 1.69 [1.53-1.86]; adjusted for age, gender, living vs deceased donor and year of transplant this was 1.22 [1.11-1.36], p<0.001. There was no interaction between the risk of cancer after NMSC and year of transplant.
In supplementary analyses (censored at loss of graft function), a similar excess risk was seen crude HR 1.56 [1.40-1.74], p<0.001; adjusted for age, gender, donor source and year of transplant this was 1.16 [1.04-1.30]. There was no interaction of this post-NMSC risk with year of transplant, nor with the use of anti-CD3 antibody therapy.
Among kidney transplant recipients, there is an increased risk of solid organ cancer after the occurrence of a NMSC. This risk is independent of other risk factors for cancer such as age, year of transplantation (a proxy for immunosuppression), anti-CD3 use. Whether this relationship marks an underlying propensity to malignant transformation, or an increased vulnerability to the carcinogenic effects of immunosuppressive therapy is not clear.
To cite this abstract in AMA style:McDonald S, Carroll R. Occurrence of Non-Melanoma Skin Cancer Predicts Risk of Subsequent Solid Organ Cancer, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/occurrence-of-non-melanoma-skin-cancer-predicts-risk-of-subsequent-solid-organ-cancer-the/. Accessed January 17, 2018.
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