Independent Pre-Transplant Recipient Cancer Risk Factors after Kidney Transplantation and the Utility of G-Chart Analysis for Clinical Process Control

Abstract

BackgroundThe aim of this study is to identify independent pre-transplant cancer risk factors after kidney transplantation and to assess the utility of G-chart analysis for clinical process control. This may contribute to the improvement of cancer surveillance processes in individual transplant centers.Patients and Methods1655 patients after kidney transplantation at our institution with a total of 9,425 person-years of follow-up were compared retrospectively to the general German population using site-specific standardized-incidence-ratios (SIRs) of observed malignancies. Risk-adjusted multivariable Cox regression was used to identify independent pre-transplant cancer risk factors. G-chart analysis was applied to determine relevant differences in the frequency of cancer occurrences.ResultsCancer incidence rates were almost three times higher as compared to the matched general population (SIR = 2.75; 95%-CI: 2.33–3.21). Significantly increased SIRs were observed for renal cell carcinoma (SIR = 22.46), post-transplant lymphoproliferative disorder (SIR = 8.36), prostate cancer (SIR = 2.22), bladder cancer (SIR = 3.24), thyroid cancer (SIR = 10.13) and melanoma (SIR = 3.08). Independent pre-transplant risk factors for cancer-free survival were age <52.3 years (p = 0.007, Hazard ratio (HR): 0.82), age >62.6 years (p = 0.001, HR: 1.29), polycystic kidney disease other than autosomal dominant polycystic kidney disease (ADPKD) (p = 0.001, HR: 0.68), high body mass index in kg/m2 (p<0.001, HR: 1.04), ADPKD (p = 0.008, HR: 1.26) and diabetic nephropathy (p = 0.004, HR = 1.51). G-chart analysis identified relevant changes in the detection rates of cancer during aftercare with no significant relation to identified risk factors for cancer-free survival (p<0.05).ConclusionsRisk-adapted cancer surveillance combined with prospective G-chart analysis likely improves cancer surveillance schemes by adapting processes to identified risk factors and by using G-chart alarm signals to trigger Kaizen events and audits for root-cause analysis of relevant detection rate changes. Further, comparative G-chart analysis would enable benchmarking of cancer surveillance processes between centers.

From kidney injury to kidney cancer

“…76 Cystic and solid kidney tumors share many similarities in terms of uncontrolled hyperplasia of renal epithelial cells 77 because of many biological similarities between ADPKD and cancer. Available data for cancer incidence in patients with ADPKD on dialysis, 78 or after transplantation, 22,79 showed an increased risk of kidney neoplasms when compared with the general population, but not to other patients on renal replacement therapy without ADPKD. 80 More recently, in a .…”

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]…”

Screening for prostate cancer in renal transplant candidates: Single-centre experience over 10 years

“…The incidence of PCa after renal transplantation seems to be elevated. [14][15][16][17] Some authors have reported that PCa after renal transplant takes a different clinical course when compared with the general population with a higher risk of local invasion and lymph node metastasis, 18 and that diagnosis of PCa is also made earlier at around 60 years of age. 18 Other studies have refuted this theory.…”