Abstract
The risk of cancer increases after transplantation. However, the consensus on immunosuppression (IS) adjustment after diagnosis of malignancy is lacking. Our study aims to assess the impact of IS adjustment on mortality of post-kidney transplant patients and allograft outcomes. We retrospectively reviewed the data in our center of 110 subjects. Our results showed IS dose adjustment was not statistically associated with mortality risk (HR 1.94, 95%CI 0.85–4.41, p = 0.12), and chemotherapy was the only factor that was significantly related to mortality (HR 2.3, 95%CI 1.21–4.35, p = 0.01). IS reduction was not statistically associated with worsening graft function (OR 3.8, 95%CI 0.77–18.71, p = 0.10), nor with graft survival (SHR 4.46, 95%CI 0.58–34.48, p = 0.15) after variables adjustment. Creatinine at cancer diagnosis and history of rejection were both negatively associated with graft survival (SHR 1.72, 95%CI 1.28–2.30, p < 0.01 and SHR 3.44, 95%CI 1.25–9.49, p = 0.02). Reduction of both mycophenolate and calcineurin inhibitors was associated with worsening graft function and lower graft survival in subgroup analysis (OR 6.14, 95%CI 1.14–33.15, p = 0.04; HR 17.97, 95%CI 1.81–178.78, p = 0.01). In summary, cancer causes high mortality and morbidity in kidney transplant recipients; the importance of cancer screening should be emphasized.
Highlights
The number of solid organ transplants has increased in the past decade, with 21,167 kidney transplants performed in the United States in 2018
After adjusting for age at cancer diagnosis, creatinine at cancer diagnosis, IS dose reduction, malignancy type, and history of rejection, our result showed that creatinine at cancer diagnosis and history of rejection have remained statistically significant with SHR 1.72, 95% CI 1.28–2.30, p < 0.01 and SHR 3.44, 95% CI 1.25–9.49, p = 0.02, respectively
Previous studies showed that sirolimus was associated with reduction in the risk of malignancy and nonmelanoma skin cancer in kidney transplant recipients; it was associated with increased mortality risk [9]
Summary
The number of solid organ transplants has increased in the past decade, with 21,167 kidney transplants performed in the United States in 2018. Multiple studies have shown that there is an increased risk of malignancy in transplant recipients [1]. The overall cancer incidence rate is 90 per 1000 patients at 10 years after transplant, which is twice as high as in the general population, while the dialysis population has a 1.35 standardized cancer incident ratio compared to the general population [2]. Nonmelanoma skin cancer is even more frequent, with an incidence rate 14 times higher in transplant recipients compared to the general population. The burden of malignancy in kidney transplant patients is very high, and the mortality risk in kidney transplant recipients diagnosed with cancer is greater than nontransplant patients. Malignancy is currently the second most common cause of death in kidney transplant patients after cardiovascular disease [3]
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