*Purpose: A history of cancer is increasingly common among solid organ transplant candidates, and transplant-associated immunosuppression may increase recurrence risk. We assessed whether transplantation was associated with an elevated mortality among cancer patients.

*Methods: Using linked data from the US transplant registry and 13 cancer registries, we compared overall and cancer-specific mortality among cancer patients with vs. without a subsequent transplant. We used Cox regression in cohort and matched control analyses, controlling for demographic factors and cancer stage.

*Results: The study included 10,524,326 cancer patients with 17 cancer types; 5425 (0.05%) subsequently underwent transplantation. The median time from cancer diagnosis to transplantation was 4.17 years. Transplantation was associated with elevated overall mortality for most cancers, especially for cervical, testicular, and thyroid cancers (adjusted hazard ratios [aHRs] 3.43-4.88). In contrast, as shown in the table for selected cancer sites, transplantation was not associated with elevated cancer-specific mortality for any cancer site, and we observed inverse associations for patients with breast cancer (aHRs 0.65-0.67), non-Hodgkin lymphoma (0.50-0.51), and myeloma (0.39-0.42).

*Conclusions: Among US cancer patients, an increase in overall mortality associated with transplantation is due to adverse effects of end-stage organ disease and transplant-related medical complications. However, there was no elevation in cancer-specific mortality, likely reflecting careful candidate selection. These results support current practices involving wait times and thorough evaluation of potential transplant candidates with previous cancer diagnoses.

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