Chronic Graft Loss and Death in Patients With Post-Transplant Malignancy in Living Kidney Transplantation: A Competing Risk Analysis

Abstract

Background:Malignancy is a common complication after renal transplantation. Death with functioning graft and chronic graft loss are two competing outcomes in patients with post-transplant malignancies.Objectives:The purpose of our study was to evaluate the risk factors associated with cumulative incidence of these two outcomes.Patients and Methods:Fine-Gray model was used for 266 cases with post-transplant malignancy in Iran. These patients were followed-up from the diagnosis until the date of last visit, chronic graft loss, or death, subsequently.Results:At the end of the study, as competing events, chronic graft loss and death with functioning graft were seen in 27 (10.2%) and 53 cases (19.9%), respectively, while 186 cases (69.9%) were accounted as censored. The incidence rate of death was approximately two-time of the incidence rate of chronic graft loss (8.6 vs. 4.4 per 100 person-years). In multivariate analysis, significant risk factors associated with cumulative incidence of death included age (P < 0.007, subhazard ratio (SHR) = 1.03), type of cancer (P < 0.0001), and response to treatment (P < 0.0001, SHR = 0.027). The significant risk factors associated with cumulative incidence of chronic graft loss were gender (P = 0.05, SHR = 0.37), treatment modality (P < 0.0001), and response to treatment (P = 0.048, SHR = 0.47).Conclusions:Using these factors, nephrologists may predict the occurrence of graft loss or death. If the probability of graft loss was higher, physicians can decrease the immunosuppressive medications dosage to decrease the incidence of graft loss.

De novononcutaneous malignancies after kidney transplantation are associated with an increased risk of graft failure: results from a time-dependent analysis on 672 patients

“…Nevertheless, the association of post‐transplant NCM with graft failure has not yet been investigated considering NCM occurrence as a time‐dependent variable and its HR has not yet been defined. Indeed, many different studies investigated graft survival since the diagnosis of a NCM, but they usually included both patients with early diagnoses – who likely have a good graft function – and patients with late diagnoses, who might have a failing graft independently from malignancy . Therefore, such studies are not able to compare directly patients with a NCM with those without a NCM and may not be able to adjust for all known malignancy‐independent risk factors.…”

“…Indeed, there could be at least two opposite situations: On the one side, immunosuppressive (IS) therapy is often reduced after a malignancy diagnosis and exposure to chemotherapy and radiation therapy is common, which may trigger or favor chronic rejection, yielding eventually to a premature graft failure. On the other side, some patients may be particularly “susceptible” to IS and therefore develop some virus‐associated malignancy (i.e., PTLD and Epstein–Barr virus (EBV), Kaposi sarcoma and Kaposi sarcoma herpesvirus (KSHV) ): These patients may be protected from chronic rejection as they might be adequately immunosuppressed even with a low‐dose IS.…”

Longitudinal Serum Creatinine Levels in Relation to Graft Loss Following Renal Transplantation: Robust Joint Modeling of Longitudinal Measurements and Survival Time Data

“…The rate of five-year survival of kidney allografts was estimated to be 82.5% in Iran in 2011 (4). Graft failure is a major clinical event, and it is defined as a return to dialysis, or death with a functioning graft (5). Unfortunately, the main determinants of both the patient’s and the graft’s survival are not yet completely understood (6, 7).…”

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients

“…Villeneuve et al [18] reported that the cancer incidence in RT patients was 2.5 times higher than rates observed in the general population. Salesi et al [19] concluded that skin cancer (52.9%) was the most frequently observed malignancy after RT, including Kaposi sarcoma, squamous cell carcinoma, basal cell carcinoma, and melanoma.…”