De Novo Cancers Arising in Organ Transplant Recipients are Associated With Adverse Outcomes Compared With the General Population

Miao, Yun; Everly, J; Gross, Thomas G.; Tevar, Amit D.; First, M. Roy; Alloway, Rita R.; Woodle, E. Steve

doi:10.1097/tp.0b013e3181a238f6

Cited by 195 publications

(176 citation statements)

References 21 publications

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“…In the transplant population, PSA screening is more complex because of evidence suggesting that PC is more aggressive in renal transplant recipients. 13,20,25,26 Nevertheless, our data demonstrate that PSA screening does not affect post-transplant patient survival (Figure 2). At most, PSA screening is associated with an improvement in graft survival in deceased-donor transplant recipients ,55 years of age ( Figure 3).…”

Section: Discussionmentioning

confidence: 65%

Utility of Prostate Cancer Screening in Kidney Transplant Candidates

Vitiello

Sayed²,

Wardenburg

et al. 2015

JASN

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Screening recommendations for prostate cancer remain controversial, and no specific guidelines exist for screening in renal transplant candidates. To examine whether the use of prostate-specific antigen (PSA)-based screening in patients with ESRD affects time to transplantation and transplant outcomes, we retrospectively analyzed 3782 male patients $18 years of age undergoing primary renal transplant evaluation during a 10-year period. Patients were grouped by age per American Urological Association screening guidelines: group 1, patients ,55 years; group 2, patients 55-69 years; and group 3, patients .69 years. A positive screening test result was defined as a PSA level .4 ng/ml. We used univariate analysis and Cox proportional hazards models to identify the independent effect of screening on transplant waiting times, patient survival, and graft survival. Screening was performed in 63.6% of candidates, and 1198 candidates (31.7%) received kidney transplants. PSA screening was not associated with improved patient survival after transplantation (P=0.24). However, it did increase the time to listing and transplantation for candidates in groups 1 and 2 who had a positive screening result (P,0.05). Furthermore, compared with candidates who were not screened, PSA-screened candidates had a reduced likelihood of receiving a transplant regardless of the screening outcome (P,0.001). These data strongly suggest that PSA screening for prostate cancer may be more harmful than protective in renal transplant candidates because it does not appear to confer a survival benefit to these candidates and may delay listing and decrease transplantation rates.

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Section: Discussionmentioning

confidence: 65%

Utility of Prostate Cancer Screening in Kidney Transplant Candidates

Vitiello

Sayed²,

Wardenburg

et al. 2015

JASN

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“…Although cancer types common in the general population (breast, cervix, prostate) appear no more frequently in LT recipients, such cancers may occur at an earlier age, be more aggressive, and be linked to poor survival (28,29).…”

Section: Malignancymentioning

confidence: 99%

Long-Term Results of Liver Transplantation

2011

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Liver transplantation (Lt) is an established therapy associated with a dramatic improvement in patients' life expectancy. With improved early-term management, current 10-year patient survival rates in many indications exceed 70%. Life-long immunosuppressive therapy may, however, be accompanied by considerable long-term toxicity: most importantly, renal dysfunction, cardiovascular disease, and cancer, which, in addition to recurrence of the primary liver disease, emerge as key contributors to late mortality. chronic kidney disease cumulatively affects up to 28% of patients by ten years after Lt. various factors can contribute to renal impairment, but perioperative acute kidney injury, calcineurin inhibitor toxicity, hypertension, and diabetes are considered most important. Lt patients demonstrate 3-fold risk for cardiovascular events, which seems to result mostly from an excess of traditional risk factors, mainly hypertension and diabetes. the cumulative cancer incidence reaches 16-42% by 20 years after Lt, and cancer rates are 2-to 4-fold higher among Lt patients than among matched controls. Highest rates are for nonmelanoma skin cancer (3-to 70-fold) and lymphoma (8-to 29-fold). the liver graft usually displays uncomplicated function in the long term. most common causes for chronic graft dysfunction include disease recurrence and biliary problems. Lt generally restores patients' quality of life to a level comparable with that of the general population, with only minor deficits in some areas. thus, long-term survival after Lt is impressive, and despite these long-term complications, patients' quality of life remains comparable with that of the general population.

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“…Cancers developed in transplant recipients were often more aggressive and developed at a much later stage than patients without transplants. Recent data from the Israel Penn Registry showed that the stage-specific survival for certain cancer types such as colon, lung, breast, prostate, and bladder cancers was significantly lower in patients with transplants compared with those in the general population (Miao et al 2009). …”

Section: Survival and Outcomes In Transplant Recipients With Cancermentioning

confidence: 99%

Cancer in the Transplant Recipient

Chapman

Webster

Wong

2013

Cold Spring Harbor Perspectives in Medicine

239

187

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Malignancy has become one of the three major causes of death after transplantation in the past decade and is thus increasingly important in all organ transplant programs. Death from cardiovascular disease and infection are both decreasing in frequency from a combination of screening, prophylaxis, aggressive risk factor management, and interventional therapies. Cancer, on the other hand, is poorly and expensively screened for; risk factors are mostly elusive and/or hard to impact on except for the use of immunosuppression itself; and finally therapeutic approaches to the transplant recipient with cancer are often nihilistic. This article provides a review of each of the issues as they come to affect transplantation: cancer before wait-listing, cancer transmission from the donor, cancer after transplantation, outcomes of transplant recipients after a diagnosis of cancer, and the role of screening and therapy in reducing the impact of cancer in transplant recipients.

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De Novo Cancers Arising in Organ Transplant Recipients are Associated With Adverse Outcomes Compared With the General Population

Abstract: These analyses indicate that, for several common cancers, transplant patients experience worse outcomes than the general population. The data also suggest that cancers in transplant recipients are more aggressive biologically at the time of diagnosis.

Cited by 195 publications

References 21 publications

Utility of Prostate Cancer Screening in Kidney Transplant Candidates

Utility of Prostate Cancer Screening in Kidney Transplant Candidates

Long-Term Results of Liver Transplantation

Cancer in the Transplant Recipient

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