Risk Factors for 1-5 Year De Novo Cancers after Kidney Transplant (KTx) with First-Year Immunosuppression (IS) Data: An Analysis of the Choosing Immune Suppression by Efficacy and Morbidity (CISTEM) Study
1Washington Univ, St. Louis, MO, 2Univ of Iowa, Iowa City, IA, 3Saint Louis Univ, St. Louis, MO, 4SRTR, Minneapolis, MN
Meeting: 2019 American Transplant Congress
Abstract number: 47
Keywords: Kidney transplantation, Malignancy
Session Information
Session Name: Concurrent Session: PTLD/Malignancies: All Topics
Session Type: Concurrent Session
Date: Sunday, June 2, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 311
*Purpose: From our CISTEM study of linked national registries, we published data on risk factors for within-3-years post-KTx non-melanoma skin cancer (NMSC) and viral-driven cancers (VDCs), based on initial IS (Dharnidharka et al, Transplant Intl 2016). For NMSC, mTORi-based initial regimens significantly reduced risk vs. reference regimen IL2R-Ab + Tac + mycophenolate + prednisone; cyclosporine-based initial regimens increased other cancer risk (Dharnidharka et al, Transplantation 2017). In this analysis, we studied risk factors for developing these cancers de novo, years 1-5, using through-first-year IS data.
*Methods: The CISTEM study links SRTR transplant data to Medicare claims and Symphony Health System pharmacy fills data, transplant years 2009-2013. Cancers were categorized as NMSC, VDCs, or other, based on ICD-9 codes. Maintenance IS was classified into the most common regimens. Cancer was defined by at least two outpatient or one inpatient claim. Patients who developed any cancer within the first year post-KTx were excluded.
*Results: Among 26,652 eligible KTx recipients (60% male, 54% white, primary renal disease diabetes in 26%, hypertension in 25%), 1013 developed NMSCs, 174 VDCs, and 694 other cancers in years 1-5 post-KTx. VDC risk was higher in all older age groups (ref 19-30 years. Patients who received thymoglobulin were nearly 70% more likely to develop VDC (aHR = 1.66, p=0.02; Figure). Patients receiving no induction were 30% less likely to develop NMSC (aHR 0.71, p=0.003). However, no maintenance IS regimens appeared to increase the risk of de novo NMSC or VDC during longer follow-up (P>0.05 for all); mTORi- based immunosuppression did not reduce the risk of NMSC (p=0.29).
*Conclusions: Induction therapy appears to have long-lasting effects on risk of specific malignancy. In contrast, known risk factors for cancers early posttransplant were not identified in this large data set. Risk factors for later onset de novo cancer appear to differ from those for early onset cancers, and include no maintenance IS regimens.
To cite this abstract in AMA style:
Dharnidharka V, Axelrod D, Zhang Z, Schnitzler M, Lentine K, Kasiske B. Risk Factors for 1-5 Year De Novo Cancers after Kidney Transplant (KTx) with First-Year Immunosuppression (IS) Data: An Analysis of the Choosing Immune Suppression by Efficacy and Morbidity (CISTEM) Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-1-5-year-de-novo-cancers-after-kidney-transplant-ktx-with-first-year-immunosuppression-is-data-an-analysis-of-the-choosing-immune-suppression-by-efficacy-and-morbidity-cistem-s/. Accessed May 12, 2025.« Back to 2019 American Transplant Congress