Influence of immunosuppression on the prevalence of cancer after kidney transplantation (original) (raw)
Related papers
Transplantation Proceedings, 2010
Introduction. The risk of malignancies in renal transplant recipients is considerably greater than in the general population. The purpose of the present study was to investigate the effects on the appearance of malignancies of 3 immunosuppressive periods: azathioprine (AZA), cyclosporine (CsA), and tacrolimus (TAC). Patients and Methods. This study included 1029 first renal transplant recipients of mean age at transplantation of 44.6 Ϯ 14.9 years with a mean follow-up of 95.6 Ϯ 84.2 months. Initial immunosuppression was AZA-based (n ϭ 198), CsA-based (n ϭ 524), and TAC (n ϭ 307). A total of 280 recipients were also treated with mycophenolate mofetil or mycophenolic acid. Results. There were 157 patients (15.3%) who displayed Ն1 malignancy; there were 95 skin (9.2%) and 74 (7.8%) non-skin malignancies with presentations at 74 Ϯ 62 and 107 Ϯ 77 months, respectively (P ϭ .003). The skin malignancies included squamous cell carcinomas (n ϭ 41), basal cell carcinomas (n ϭ 41), Kaposi sarcomas (n ϭ 7), and melanomas (n ϭ 4). Among the solid tumors, lymphoproliferative disorders (n ϭ 15), digestive tract (n ϭ 14), kidney and urinary tract (n ϭ 11), lung (n ϭ 10), and breast (n ϭ 3) carcinomas. The cumulative incidences at 5, 10, and 15 years were 6%, 10%, and 18% for skin and 3%, 7%, and 14% for non-skin malignancies, respectively. Multivariate analysis showed that age at transplant in years (P ϭ .000) and male gender (P ϭ .000) were the only variables associated with skin malignancies; age at transplant in years (P ϭ .004) and treatment with OKT3 (P ϭ .000) were associated with non-skin malignancies. Malignancies were the cause of death in 18% of recipients who died with functioning grafts. Conclusion. Malignancies are an important cause of morbidity and mortality among renal transplant recipients. The new immunosuppressive agents do not increase the risk of malignancies. Special surveillance is needed for older, male recipients.
Malignancy after renal transplantation: Incidence and role of type of immunosuppression
Annals of Surgical Oncology, 2002
Background: Cancer, particularly skin cancer and lymphoma, is a complication of posttransplantation immunosuppression. We investigated the characteristics of cancers in our renal transplant population, the role of type of immunosuppression on cancer incidence, and whether newer, more potent immunosuppressive agents produce cancers sooner after transplantation.
Risk of malignancy with long-term immunosuppression in renal transplant recipients
Kidney International, 2004
Risk of malignancy with long-term immunosuppression in renal transplant recipients. Background. Improvements in immunosuppressive regimens have significantly enhanced patient and graft survival in renal transplant recipients. However, susceptibility to neoplastic disorders is increased as a consequence of prolonged immunosuppression. Available data pertaining to cancer risks in renal transplant recipients have been inconsistent, and much of it is derived from international studies, which may not be truly representative of the United States population. Methods. We studied a total of 1979 transplants performed in 1739 patients from a single center in the United States with a mean follow-up of 6.1 years, and a total of 9852 person-years' follow-up. Results. The mean age at the time of diagnosis of cancer was 50 years, and the mean interval between transplant and diagnosis of cancer was 95 months. Older patients receiving a transplant had a significantly higher risk for developing cancer as opposed to younger patients (RR 6.2 for >60 years compared with <40 years). When compared with the general population using data from the Surveillance, Epidemiology and End Results (SEER) registry, the overall risk for nonskin malignancies was modestly increased in our transplant recipients, with a standardized incidence ratio (SIR) of 1.4 (P = 0.01). When stratified by age groups, younger age at transplant (<40 years) had the highest SIR, at 2.3 (P < 0.001). Similarly, duration posttransplant >10 years had an SIR of 2.4 (P < 0.001). Conclusion. We believe that this study is representative of the United States' renal transplant population, and highlights the need for reduced immunosuppression in the long-term and increased vigilance for cancers in younger patients receiving renal transplantation. Improvements in immunosuppressive regimens and general care of the renal transplant recipient have led to
Cancer incidence in a kidney-transplanted population
Transplant International, 1994
A study on cancer incidence after kidney transplantation was performed using data of national transplant and cancer registries. Since 1964 up to 30 June 1997, 3440 kidney transplantations were performed on 2890 patients. From 1967 to 1997, 230 posttransplantation malignancies were found in 20,817 patient-years of follow up. The standardised incidence ratio (SIR) was 3.33 compared to the general population. The SIR was highest in skin cancer (39.2). The SIRs were high in cancers of the lip (23.0), thyroid (8.08), kidney (8.0), lower urinary tract (3.2), non-Hodgkin lymphoma (4.8), ovary (3.9) and colon (3.9). Skin cancer and lymphomas had much higher SIRs in men than in women whereas lower urinary tract cancer had a higher SIR in women. During the first 10 follow up years, life-table analysis indicates a higher cancer risk in cyclosporine-treated patients, but this may be biased by their shorter follow up as the overall SIR was equal in both groups. This population study shows the increased incidence of cancer in the transplant population and points out the importance of cancer surveillance in the years following kidney transplantation.
Malignancies after renal transplantation during 33 years at a single center
Pathology & Oncology Research, 2007
One hundred ninety-three malignant diseases were found in 188 patients (7.6%). The incidence of thyroid-, renal-hepatic-, skin-and gastric cancers as well as of Kaposi sarcoma and lymphomas increased in our transplant patient cohort compared to the figures of the general population based on the data of our Cancer Registry. On the other hand, colorectal-, oralprostate and lung cancers were underrepresented in our patient cohort. The mean time of diagnosis of malignancies following kidney transplantation was 58.5±44.8 months. One fifth of the tumors were detected within the first year. Patients with malignancies were distributed into four groups based on the immunosuppressive regimen: group I (8.5%), azathio-prine + prednisone; group II (59.0%), cyclosporine + prednisone; group III (26.6%), cyclosporine + mycophenolate mofetil + prednisone; group IV (5.9%), tacrolimus + mycophenolate mofetil + prednisone. The mean age of patients was 47.3, 53.5, 55.5 and 58.1 years in group I, II, III and IV, respectively. Oncologic and immunosuppressive therapy was decided individually. Immunosuppression was switched to rapamycin-containing regimens in 63 cases. We lost 92 patients (48.9%) with a mean survival time of 25.8±39.4 months. Cumulative 1-and 5-year survivals were 69.5% and 52%, respectively. The increasing number of cancers seen early after transplantation and the increased risk of developing a cancer due to the older age of recipients draw attention to the importance of regular oncologic screening in patients on the waiting list and after transplantation.
Malignancy after kidney transplantation: results of 400 patients from a single center
Clinical Transplantation, 2008
Post-transplant malignancies (PTM) occur in a percentage as high as 50% in patients followed 20 yr and have become a main cause of mortality and are expected to be the first cause of death within the next 20 yr in kidney transplant recipients. We analyzed the PTM incidence in our kidney transplant recipients, and its main risk factors. The records of 400 patients (min follow up = one yr) have been retrospectively reviewed and categorized into three groups: patients without any tumor, with a non-melanoma skin cancer and with a solid or hematologic cancer. A cancer-free multivariate survival study was performed stratified by age, sex, immunosuppressive therapy, time on dialysis, body mass index (BMI), smoke, diabetes and nephropathy. Thirty patients developed PTM: 12 non-melanoma skin cancer, three lymphomas and 15 solid malignancies (seven genitourinary, three lung, two breast, two gastrointestinal and one sarcoma). The mean age at diagnosis was 55 yr, with a mean time from transplant of 27 months. We observed six deaths and two graft losses. Non-melanoma skin cancer-free survival and the solid/hematologic cancer-free survival was 99.5% and 98.5% at one yr, and 95.2% and 94.6% at five yr, respectively. At univariate analysis, age and induction therapy were significant risk factors for both types of PTM, while only recipient age significantly increased the risk of all PTM, and anti CD25 significantly reduced the risk of non-melanoma skin cancer at the multivariate study. These data confirm the role of age and induction strategies in modulating the risk of neoplasia. To look for which strategies might reduce the PTM risk, including a personalized therapy to minimize the effects of chronic immunosuppressant, will be a crucial goal.
Excess risk of cancer in renal transplant patients
Transplant International, 2006
Cancer data were reviewed in 488 patients who underwent renal transplantation and received cyclosporine at our centre from January 1985 to December 1995. Incidence of nonmelanoma skin cancer (NMSC) was standardized on the age and sex distribution of the French population. For cancer other than NMSC, we calculated the ratio of observed to expected numbers of cancer cases in the RT population, based on age- and sex-specific incidence for cancer in France. Standardized incidence ratios (SIR) were calculated for all cancers and for specific cancer types encountered. Over 4,638 patient-years of exposure, 51 (10.4%) transplant recipients developed a first NMSC which was significantly associated with older age at transplantation (P &amp;amp;amp;amp;amp;lt; 0.0001) and the 1991-1995 transplantation period (P = 0.0008). Fifty-six recipients developed cancer other than NMSC over the period. The SIR for all cancer was 2.2 (1.5-3.0) in males and 3.0 (1.9-4.6) in females. The SIR for specific cancer types revealed significant excess for native kidneys [13.0 (5.2-26.8)] prostate cancer [3.6 (1.5-3.0)] and post-transplant lymphoproliferative disorder (PTLD) [9.5 (3.1-22.1)] in males, and cervical cancer [25.3 (9.3-55.0)], native kidneys [26.4 (5.4-77.2)] and PTLD [28.9 (9.4-67.6)] in females. Incidence of NMSC and some types of other cancer is high in cyclosporine-treated patients. Optimizing monitoring practice might be useful to identify subjects with significant excess risk for specific types of solid tumours.