ABSTRACT

A 1.5-fold increased incidence of lung cancer has been noted in patients after kidney transplantation (KT). Risks factors and clinical outcomes have not been previously studied.

METHODS

We compared the incidence of lung cancer in patients receiving a KT at our center from March 1997 to December 2011 (n=884) to the incidence of lung cancer from the Surveillance Epidemiology and End Results (SEER) database, using age and gender matched populations. Data were expressed as standardized incidence ratios (SIR) and excess absolute risk (EAR). Lung cancer risk factors were compared to 200 consecutive KT recipients from 2004-2008 who did not develop lung cancer.

RESULTS

Sixteen patients developed lung cancer after transplant for an observed incidence of 415 cases per 100,000 person-years (SIR 3.05 [95% CI 1.74-4.95], EAR 340.92 per 100,000 person-years) compared to the expected 74.3 cases per 100,000 years from the SEER-derived comparison group and to the observed incidence of 115.3 per 100,000 person-years from the US Transplant Registry.

Adenocarcinoma was the most common (11/16), followed by squamous cell carcinoma (4/16). The majority had stage III or IV disease on presentation (68.8%). The median time to diagnosis from transplant was 4.6 years; four (25%) were diagnosed within the first year. Advantaged age at the time of KT (OR 5.43, P 0.002), tobacco use (P <0.01), personal (OR 5.5, P 0.002) and family history (OR 6.1, P 0.001) of cancer were associated with lung cancer.

CONCLUSION

We observed a higher incidence of lung cancer after KT. Based on these data, careful consideration should be given prior to listing transplant candidates who are current smokers, have a prior history of lung cancer, or are older than 60 with prior history of cancers.

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