*Purpose: Individuals who wish to donate a kidney for transplantation are evaluated for transmissible diseases (including cancer) prior to donation. Outcomes in LKDs after donation are typically excellent, although there is a slightly elevated risk of developing chronic kidney disease. Little is known about cancer risk following donation. Chronic kidney disease is a risk factor for kidney cancer, which suggests that LKDs may have increased risk for this malignancy. One study of 4650 LKDs found an elevated incidence of prostate cancer (Lentine, Transplantation 2012).

*Methods: We assessed cancer risk in a cohort of LKDs through linkage of the US transplant registry with 17 cancer registries. Cancer risk in LKDs relative to the general population was quantified using standardized incidence ratios (SIRs). The SIR for kidney cancer was corrected for the fact that LKDs have only a single kidney by dividing the expected count by 2.

*Results: 67,644 LKDs were followed for 650,366 person-years after donation (1987-2017). N=1928 invasive cancers were diagnosed during follow-up. Risk was decreased relative to the general population for cancer overall (SIR 0.63, 95%CI 0.60-0.66) and was not significantly elevated (threshold p<0.05) for any of 45 specified cancer types. Risk was decreased compared with the general population for common cancers including colorectum (SIR 0.52, 95%CI 0.44-0.62), lung (0.52, 0.45-0.60), breast (0.74, 0.67-0.81), and non-Hodgkin lymphoma (0.51, 0.40-0.64). Among urinary tract cancers, risk was reduced for cancers of the kidney (SIR 0.57, 95%CI 0.38-0.82) and bladder (0.38, 0.23-0.60), and similar to the general population for prostate cancer (0.93, 0.83-1.04). Risk was greatly reduced for liver cancer (SIR 0.05, 0.01-0.17).

*Conclusions: In this large population-based study, we found that LKDs have a lower risk for cancer overall and for several common cancers relative to the general population. In particular, risk is not elevated for kidney or prostate cancers. This pattern may reflect screening prior to donation and deferral of individuals with cancer or other transmissible diseases (e.g., HIV, hepatitis B or C virus infection), as well as the overall good health and lifestyle of LKDs.

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