De novo malignancy in organ transplant recipients in Taiwan: a nationwide cohort population study

Abstract

Organ transplant recipients appear to have a higher risk of de novo malignancy. The aim of the study was designed to estimate cancer risk in heart, lung, kidney and liver transplant recipients. The cohort study used the Taiwan National Health Insurance Research Database (1996-2011) and followed the outcomes of organ recipients until 2012. De novo cancer and mortality rates after organ transplantation were evaluated using standardized incidence ratios, excess absolute risks of cancer, and standardized mortality ratios in recipients were compared with those in the general population. We identified 40, 231, 2, and 115 patients who developed cancer after heart, kidney, lung, and liver transplantation, which corresponded to a cancer incidence of 878.4, 1101.2, 728.9, and 1361.4 cases per 100,000 person-years, respectively. In heart, kidney, lung, and liver recipients, the overall standardized incidence ratios were 1.65 (1.21-2.24), 3.33 (2.93-3.79), 1.82 (0.45-7.27) and 3.37 (2.81-4.05) and the overall standardized mortality ratios were 5.45 (4.96-5.98), 1.47 (1.34-1.61), 8.92 (7.10-11.20), and 3.83 (3.48-4.20), respectively. These results reveal a three-fold increase in de novo cancer risk in organ transplant patients compared with the general population. This study illustrated the importance of de novo malignancy after organ transplantation.

De novo cancer incidence after kidney and liver transplantation: Results from a nationwide population based data

“…In previous studies targeting Western populations, the excess risk of Kaposi sarcoma incidence was prominent with the SIR value of 40 or more 8,9 , reached to more than 100 19 . Studies in Asian populations did not show the SIR of Kaposi sarcoma due to unavailable incidence rate in general population 14 or lower SIR value 16,24 than our results. The incidence of Kaposi sarcoma is lower in the general population with Asian ethnicity than other populations 25 , especially in Korean population 26 , and it would be the reason of the extremely high SIR despite the small number of cases in transplantation recipients.…”

“…Incidence of cancers in bladder (female) and kidney (both genders) in kidney recipients, as well as liver cancer in liver transplant recipients were higher than the general population which were comparable with previous studies 2,8–10,13–16 . The elevated cancer risk at the respective transplantation site would be related to the indication of transplantation.…”

“…A leukemia risk after solid organ 8,30 or liver transplantation 16 was also observed in this study, and was especially higher in younger individuals (data not shown). Immune dysfunctions or immune suppression are suggested to be an etiology of increased risk 30 .…”

“…In this study we grouped cancers as ICD-10 code C40-C49, except Kaposi sarcoma (C46) due to small number of each type of cancer, and skin cancer accounted for most of them (31 of 35 in kidney recipients and 7 of 10 in liver recipients). Skin cancer after transplantation is considered one of the main concerns in Western countries with most common post-transplantation malignancy 8–10,19 , but in Asian countries, studies showed various risks of skin cancer including increased risk 13,16 , non-significantly increment 14 , or not considered due to limited number of cases in general population 24 . For the cause of skin cancer after transplantation, not only viral infection whose evidence was inconsistent 28,29 but also UV light exposure and other carcinogens are suggested 9 .…”

Advanced native-kidney carcinoma in a heart- and kidney-transplanted patient: a case report

“…Considering the great progress in the reduction of acute rejection incidence and in the treatment of early infective complications, long-term follow-up with careful monitoring for chronic renal dysfunction, graft vasculopathy, and occurrence of neoplasms has become a central issue for long-term survival and quality of life of TRs. In such a scenario, while deaths related to acute rejection and infectious complications have been decreasing, malignancies seriously jeopardize the life expectancy of transplanted patients [1].…”