Abstract
Post-transplant malignancy (PTM) is a leading cause of premature mortality among kidney transplantation recipients. However, population-based cohort studies that cover incidence, mortality, and risk factors for PTM are rarely reported, especially in East Asia. We designed a retrospective cohort study using a national population-based database. A total of 9915 kidney recipients between 2003 and 2016 were included. During this period, 598 cases (6.0%) of de novo PTM occurred. The most common PTM was thyroid cancer (14.2%), followed by colorectal (11.2%), kidney (10.7%), and stomach cancers (8.9%). The standardised incidence ratio for all-site cancer was 3.9. The risks of Kaposi sarcoma (192.9) and kidney cancer (21.1) were more than 10 times those of the general population. Cancer-related deaths were 89 (14.9%) with liver cancer being the highest (14.6%), followed by lung cancer (13.5%), non-Hodgkin lymphoma (NHL) (12.4%), stomach cancer (9.0%), and colorectal cancer (7.9%). The standardised mortality ratio (SMR) was slightly elevated (1.4). A notable increase in SMR was observed for lymphoma (9.3 for Hodgkin lymphoma and 5.5 for NHL). Older age and graft failure were significantly related to PTM. These findings reflecting geographical variation have implications for the development of strategies for fatal cancers to prevent premature deaths from PTM.
Highlights
Post-transplant malignancy (PTM) is a leading cause of premature mortality among kidney transplantation recipients
Hwang et al.[11] presented stomach cancer and malignant lymphoma as the most common PTMs based on a 40-year single-centre dataset
There was a higher proportion of recipients who suffered from graft failure in the PTM group than the non-PTM group (P < 0.001)
Summary
Post-transplant malignancy (PTM) is a leading cause of premature mortality among kidney transplantation recipients. Population-based cohort studies that cover incidence, mortality, and risk factors for PTM are rarely reported, especially in East Asia. Older age and graft failure were significantly related to PTM These findings reflecting geographical variation have implications for the development of strategies for fatal cancers to prevent premature deaths from PTM. Hwang et al.[11] presented stomach cancer and malignant lymphoma as the most common PTMs based on a 40-year single-centre dataset. Mortality data derived from PTM and risk factors for PTM were limited in the previous studies. A large population-based study with a lengthy follow-up is essential in order to understand PTM and establish cancer surveillance strategies for kidney recipients
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