Post-Transplant Malignancy in Incompatible Kidney Transplantation: A National Study.

Abstract

Introduction: Desensitization for HLA-incompatible kidney transplantation (IKT) requires additional immunosuppression compared to compatible patients, potentially leading to an increased rate of malignancy. No national studies have compared post-transplant malignancy rates in HLA-IKTs to compatible patients. Methods: Data on IKT status was collected on 3,683 patients with Medicare from 20 centers nationally. Patients were linked to Medicare claims data those with diagnoses of malignancy within 3 years post-transplant were identified. Rates of malignancy were compared between IKT patients and an age and gender matched cohort of compatibles, using Fisher's exact test as appropriate for small sample sizes. Results: IKTs were significantly less likely to develop multiple myeloma compared to non-IKTs (0 IKTs versus 18, 0.87% of non-IKTs, p =0.036, Table 1). Rates of Hodgkin's disease and non-Hodgkin's lymphoma were 1.69 and 2.06 times higher among IKTs; however, these differences were not statistically significant. IKTs had 2.75 times the rate of head and neck cancer and 2.06 times the rate of stomach cancer (not statistically significant). Discussion: Rates of most malignancies were similar 3 years post-transplant. Multiple myeloma may be less common in IKTs due to use of B-cell ablative therapies for induction and treatment of antibody mediated rejection. Rates of cancers with an infectious component (e.g non-hodgkins lymphoma, head and neck cancer) may be elevated in IKTs due to intense immunosuppression; however, longer follow-up is needed to determine if differences are significant.Table: No Caption available.