Incidence, risk factors and outcomes of malignancies after kidney transplantation in Singapore: a 12-year experience

Abstract

INTRODUCTION Data on malignancy after kidney transplantation (KTX) is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients. METHODS A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Diseases Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX. RESULTS 31 patients (61.3% male) developed malignancy during this period, and their median age at diagnosis was 50 (range 18-65) years. Median time to malignancy diagnosis was 2.6 (range 0.3-7.9) years, with cumulative incidence of 1%, 4% and 10% at one, five and ten years, respectively. The commonest malignancy type was lymphoma, followed by kidney cancer, colorectal cancer and malignancy of the male genital organs. Multivariate analysis identified cyclosporine use as an independent risk factor for malignancy. Compared to the general population, KTX recipients had higher malignancy and mortality rates after malignancy diagnosis (SIR 3.36; SMR 9.45). Survival rates for KTX recipients with malignancy versus those without malignancy were 100%, 93% and 64% versus 97%, 93% and 83% at one, five and ten years, respectively. CONCLUSION KTX was associated with higher mortality and incidence of malignancy. Newer immunosuppressive agents and induction therapies were not found to be risk factors for malignancy, possibly due to our relatively small sample size.

Cancer Risks in Solid Organ Transplant Recipients: Results from a Comprehensive Analysis of 72 Cohort Studies

“…Supplementary Table S3 provides details of the included studies, which involved e1848068-2 a total of 2,105,122 solid organ transplant recipients and reported 45 types of site-specific cancer. Of them, 52 studies 7,8,75 provided SIRs of multiple cancers of solid organ transplantations (11 for multiple organs, 7,8,[17][18][19][20][21][22][23][24][25] 19 for kidney, [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] 16 for liver, [45][46][47][48][49][50][51][52][53][54][55]75 7 for heart and/or lung [60][61][62][76]…”

Alteraciones neoplásicas en el paciente trasplantado renal. Una revisión sistemática

“…El segundo trasplante se relacionó con un mayor riesgo para el desarrollo de malignidades postrasplante. que en la general, y, por tanto, una complicación potencial a tener en cuenta en estos pacientes [24][25][26][27][28][29][30][31][32][33][34][35][36][37] .…”

“…Con respecto al sexo de los pacientes, a excepción de un solo artículo en el que dicha población fue exclusivamente femenina 37 , el resto nos ha permitido observar y comprobar la diferencia entre ambos sexos [24][25][26][27][28][29][30][31][32][33][34][35][36] .…”

“…Comenzando con la incidencia del cáncer, es destacable que en estos 13 artículos restantes [24][25][26][27][28][29][30][31][32][33][34][35][36] , todos ellos reflejan una incidencia mayor en hombres que en mujeres, en una proporción aproximada del 65% frente al 35%. Sin embargo, también hay que tener en cuenta, que, en casi la totalidad de estos, la mayor parte de la población que se sometía a un TR era masculina, a excepción de dos artículos en los que predominaba el sexo femenino, aunque también se obtuvo mayor incidencia del cáncer en hombres 31,34 . De este modo, si analizásemos la incidencia de manera individualizada entre sexos, los resultados son más similares.…”

“…De hecho, muchos de estos estudios analizaban si el sexo verdaderamente influía en el desarrollo de esta complicación, y, en todos ellos a excepción de uno, se obtuvo un resultado negativo, no mostrando de este modo una asociación significativa entre el género y la aparición de neoplasias malignas tal y como se ha obtenido en el resultado anteriormente mencionado 26,28,29,31,33,34 .…”