Abstract
Administrative data are frequently used for epidemiological studies but its usefulness to analyze cancer epidemiology after kidney transplantation is unclear. In this retrospective population‐based cohort study, we identified every adult kidney‐alone transplant performed in England (2003–2014) using administrative data from Hospital Episode Statistics. Results were compared to the hospitalized adult general population in England to calculate standardized incidence and mortality ratios. Data were analyzed for 19,883 kidney allograft recipients, with median follow‐up 6.0 years' post‐transplantation. Cancer incidence was more common after kidney transplantation compared to the general population in line with published literature (standardized incidence ratio 2.47, 95% CI: 2.34–2.61). In a Cox proportional hazards model, cancer development was associated with increasing age, recipients of deceased kidneys, frequent readmissions within 12 months post‐transplant and first kidney recipients. All‐cause mortality risk for kidney allograft recipients with new‐onset cancer was significantly higher compared to those remaining cancer‐free (42.0% vs. 10.3%, respectively). However, when comparing mortality risk for kidney allograft recipients to the general population after development of cancer, risk was lower for both cancer‐related (standardized mortality ratio 0.75, 95% CI: 0.71–0.79) and noncancer‐related mortality (standardized mortality ratio 0.90, 95% CI: 0.85–0.95), which contradicts reported literature. Although some plausible explanations are conceivable, our analysis likely reflects the limitations of administrative data for analyzing cancer data. Future studies require record linkage with dedicated cancer registries to acquire more robust and accurate data relating to cancer epidemiology after transplantation.
Highlights
Kidney transplantation is acknowledged as the treatment of choice for people with end-stage kidney failure, but the need for lifelong antirejection therapy to prevent allograft failure is associated with the development of immunosuppression-related complications [1]
Cancer incidence was more common after kidney transplantation compared to the general population in line with published literature
Cancer-related mortality has been shown to be higher among kidney allograft recipients compared to the general population in cohorts from England [6] and Ontario, Canada [13], equivalent cancer-related mortality was observed in a US cohort [5]
Summary
Kidney transplantation is acknowledged as the treatment of choice for people with end-stage kidney failure, but the need for lifelong antirejection therapy to prevent allograft failure is associated with the development of immunosuppression-related complications [1]. Analysis of cancer-related mortality was not always undertaken among the cancer incident cohort. This is important as reporting risk for cancer-related mortality in isolation will be skewed by increased incidence. Risk for cancer versus noncancer death among kidney allograft recipients after developing cancer is often overlooked. This is important because increased rates of cancer incidence after transplantation may not directly lead to cancer-linked mortality as competing risks for death occur after kidney transplantation in the context of immunosuppression (e.g., cardiovascular events or infection)
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