Abstract
There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 ± 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 ± 20 μmol/L. At a median follow-up of 7.0 (IQR, 6.2–7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34–0.74; p < 0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83–1.62; p = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR.
Highlights
Kidney transplantation improves the prognosis of patients with end-stage renal disease (ESRD), kidney transplant recipients (KTR) remain at higher mortality risk compared to healthy individuals [1]
We show that cancer is a substantially prevalent individual cause of death after kidney transplantation, and that plasma vitamin C concentrations are inversely and independently associated with long-term cancer mortality risk in stable KTR
Cancer mortality has been previously described as an increasing and imperative problem in KTR [2,5,6,10], there is a paucity of studies exploring potential risk factors and underlying mechanisms leading to this increased cancer mortality in KTR
Summary
Kidney transplantation improves the prognosis of patients with end-stage renal disease (ESRD), kidney transplant recipients (KTR) remain at higher mortality risk compared to healthy individuals [1]. Since the beginning of kidney transplantation, the main cause of death has been cardiovascular [2,3,4]. There has been a changing trend in mortality causes in KTR, with a decline in death due to cardiovascular causes along with a relative increase in cancer mortality [2,5,6,7]. Noteworthy is that overall risk of death associated with cancer in KTR is ten-fold higher than in the general population [9]. Given this relative increase in cancer mortality in KTR, further studies to explore potential risk factors and underlying mechanisms are needed
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