Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: As the long-term patient survival and graft survival rate are gradually increasing in kidney transplant (KT) recipients, the importance of cancer occurrence and proper management in transplant recipients is emphasized. However, the differences of graft survival in cured and uncured cancer compared to non-cancer patients are not yet known.
*Methods: This retrospective study included patients who had KT between 1995 and 2017. Patients who were diagnosed with any kind of cancer were identified by review of medical record. Among them, cured cancer was defined as the patients who had surgery alone or as adjuvant therapies with surgery, followed by periodic follow-up without additional treatment. Patients who continued palliative treatment were defined as uncured cancer.
*Results: A total of 1738 patients were enrolled, of which cancer was found in 115 patients. Of these, 76 were cured and 39 were uncured cancer. Cured and uncured cancer patients were older than non-cancer patients, had less use of basiliximab as an induction regimen, and had more use of cyclosporine and azathioprine as maintenance immunosuppressant. In the unadjusted analysis, the hazard ratio of death-censored graft failure (DCGF) was significantly increased in cured cancers compared to non-cancer patients (HR 2.07; 95% CI 1.29-3.32; P=0.002), but the statistical significance of DCGF risk disappeared after multivariate adjustment including maintenance agents before and after cancer (adjusted HR 1.76; 95% CI 0.86-3.58; P=0.120). Uncured cancer was not associated with DCGF in unadjusted and adjusted analyzes. Patient mortality did not increase in cured cancers, but increased only in uncured cancers. Subgroup analysis was performed according to the change of the immunosuppressive agent before and after the cancer, considering that the risk change in the multivariate analysis may be due to the specific variable included in adjustment. In patients with cured cancer who were stopped or maintained mycophenolic acid (MPA) after diagnosis, DCGF was increased only in patients who discontinued MPA (MPA hold : aHR 5.17; 95% CI 1.21-22.12; P 0.027, MPA maintained : aHR 1.54; 95% CI 0.70-3.37; P=0.281). Uncured cancer was not associated with the risk of DCGF regardless of MPA status.
*Conclusions: The overall risk of DCGF is not increased in cured cancers, but the risk of DCGF is clearly increased in some cured cancers that discontinued MPA after diagnosis of cancer. Therefore, the risk of graft failure does not increase with appropriate cancer treatment after diagnosis, but the appropriate modulation of immunosuppressive regimen should be important after cancer diagnosis.
To cite this abstract in AMA style:Kim J, Ha J, Min S, Lee H, Kim Y, Han S. Post-Transplant Cancer and Graft Failure in Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplant-cancer-and-graft-failure-in-kidney-transplant-recipients/. Accessed July 8, 2020.
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