*Purpose: Incident cancers developing after kidney transplantation are associated with significant morbidity and mortality and therefore age-appropriate cancer screening is recommended to identify asymptomatic cancers prior to transplantation. However, incident cancers can develop early after transplantation but the characteristics and outcomes of these early cancers remain poorly defined. The aim of this study is to examine the types, stage and clinical outcomes of incident cancers occurring within the first 12 months after kidney transplantation.

*Methods: Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry, recipients of first live and deceased donor kidney transplants in Australia and New Zealand who had developed de novo cancer were included. Recipients with a prior history of cancer before transplantation (n=844) were excluded. The types, stage and clinical outcomes of early (occurring ≤12 months) and late-onset incident cancers (>12 months) post-transplant were compared.

*Results: Of 2759 recipients who have developed de novo cancer after transplant, 243 (6.7%) occurred ≤12 months post-transplant. Recipients with early cancer were older (mean [SD] age: 51 [15] vs. 45 [14] years, p<0.001) and were more likely to have diabetes (19% vs. 11%, p=0.002) compared to those with late cancers. Lymphoproliferative disease, urinary tract cancer and melanoma were the 3 most common cancers occurring in the first 12 months (26%, 18% and 12%, respectively) and beyond 12 months post-transplant (14%, 14% and 11%, respectively). Over 25% of the early cancers have spread to lymph nodes or have metastasized at time of diagnosis, the latter occurring in over 30% of colorectal and lung cancers. Thirty-two and 37% of recipients with early and late cancers, respectively died from cancer during follow-up, particularly recipients with early colorectal, other gastro-intestinal and lung cancers. Over 60% of recipients with early metastatic cancers were recorded to have no specific anti-cancer treatments.

*Conclusions: Early cancers are not an infrequent complication after kidney transplantation, with cancer deaths occurring in 1 in 3 recipients. Further exploratory analysis may enable clinicians to recognise the characteristics and exposures that may be contributing to these early cancers.

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