*Purpose: Cancer is the second leading cause of post-transplant mortality. Since racial disparities have been reported in many aspects of transplant care, we sought to determine wether these disparities extend to post-transplant cancer mortality.

*Methods: Using data from USRDS and SRTR, we studied adult, Medicare primary kidney transplant recipients from 1999 through 2014. We studied the 6 most common cancers following kidney transplantation (non-Hodgkin’s lymphoma, lung, breast, prostate, kidney, and colorectal), which were identified using validated ICD-9 codes. We used multivariable Cox regression, treating cancer as a time-varying exposure, to determine the association between race and post-transplant cancer mortality.

*Results: Among 120,031 kidney transplant recipients, 15,375 (12.5%) developed post-transplant cancer. The most frequently diagnosed cancers were non-Hodgkin’s lymphoma (31.3%) and kidney cancer (24.5%). Of those with a post-transplant cancer, 33.0% underwent surgery, 5.8% underwent radiation, 2.1% underwent chemotherapy 2.1% underwent chemotherapy, and 10.1% underwent combined treatment. Overall, recipients with a post-transplant cancer had a 3.82-fold increased risk of mortality compared to those who did not develop cancer (adjusted Hazard Ratio (aHR):_3.673.82_3.98,p<0.001); however this relationship varied by race (Table 1). White recipients who developed cancer (aHR:_4.224.45_4.69, p<0.001) had a higher adjusted hazard ratio for mortality than all other racial groups: Black/African American (aHR:_2.712.90_3.11, p for interaction<0.001), and Hispanic (aHR:_3.133.50_3.92, p for interaction<0.001).

*Conclusions: Despite the typically worse outcomes for Black/African American transplant recipients, in our study we found worse outcomes among Caucasians. Additional work is necessary to identify causes of these differences and how best to mitigate them.

« Back to 2019 American Transplant Congress