Post-Transplant Malignancies following Pancreas Transplantation: Incidence and Implications on Long-Term Outcome from a Single-Center Perspective.

Felix J Krendl,Christian Margreiter,Manuel Maglione,Rupert Oberhuber,Benno Cardini,Claudia Bösmüller,Thomas Resch,Stefan Scheidl,Annemarie Weissenbacher,Stefan Schneeberger,Franka Messner,Dietmar Öfner

doi:10.3390/jcm10214810

Felix J Krendl, Christian Margreiter + Show 10 more

Open Access

https://doi.org/10.3390/jcm10214810

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Abstract

Chronic immunosuppression is associated with an increased risk of malignancy. The main objective of this study is to evaluate the incidence and effect of post-transplant malignancies (PTMs) following pancreas transplantation. The 348 first pancreas transplants performed between 1985 and 2015 were retrospectively analyzed in this study. Incidences of PTMs, as well as patient and graft survival, were evaluated. Out of 348 patients, 71 (20.4%) developed a PTM. Median time to diagnosis was 130 months. Thirty-six patients (50.7%) developed skin cancers (four patients with melanoma, 32 with NMSCs). Solid organ malignancy occurred in 25 (35.2%), hematologic malignancy in ten patients (14.1%). Affected patients were transplanted earlier [2000 (IQR 1993−2004) vs. 2003 (IQR 1999−2008); p < 0.001]. No differences in induction therapy were seen, both groups demonstrated comparable patient and graft survival. Pancreas transplant recipients with solid organ and hematologic malignancies had a three- and six-fold increased hazard of death compared to those with skin cancers [aHR 3.04 (IQR 1.17–7.91); p = 0.023; aHR 6.07 (IQR 1.87–19.71); p = 0.003]. PTMs affect every fifth patient following pancreas transplantation. Skin cancers are the most common malignancies accounting for 50% of all PTMs. These results underscore the importance of close dermatologic follow-up.

Highlights

Since the first pancreas transplantation in 1966, outcomes have improved consistently due to technical advances, meticulous pretransplant recipient evaluation, and new immunosuppressive regimens [1,2,3,4]
Our analysis demonstrated that post-transplant malignancies (PTMs) affect patient after pancreas transplantation
Skin cancers are the most common malignancies accounting for 50% of all PTMs

Summary

Introduction

Since the first pancreas transplantation in 1966, outcomes have improved consistently due to technical advances, meticulous pretransplant recipient evaluation, and new immunosuppressive regimens [1,2,3,4]. 75% for simultaneous pancreas kidney (SPK) transplantation, respectively, and even long-term pancreas graft survival of 20 years and more has been reported [5,6]. Longterm graft survival means long-term immunosuppressive therapy for the transplant recipient. Solid organ transplant recipients (SOTRs) who receive chronic immunosuppressive therapy are at an increased risk to develop malignancies [7,8,9,10,11,12,13]. SOTRs have a two- to four-fold increased risk to develop PTMs compared to the general population [8,10,14,15,16]. Pancreas transplant recipients may be especially vulnerable regarding the development of post-transplant malignancies (PTMs)

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