Risk of Hepatobiliary Cancer After Solid Organ Transplant in the United States
Published Date:Dec 19 2013
Source:Clin Gastroenterol Hepatol. 2013; 12(9):1541-9.e3.
Pubmed Central ID:PMC4064001
Funding:1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
1US58/DP0039311-01/DP/NCCDPHP CDC HHS/United States
5658DP000805-04/DP/NCCDPHP CDC HHS/United States
5U58DP000812-03/DP/NCCDPHP CDC HHS/United States
5U58DP000824-04/DP/NCCDPHP CDC HHS/United States
5U58DP003875-01/DP/NCCDPHP CDC HHS/United States
HHSH234200537009C/PHS HHS/United States
HHSH250201000018C/PHS HHS/United States
HHSN261201000024C/PHS HHS/United States
HHSN261201000026C/PHS HHS/United States
HHSN261201000027C/PHS HHS/United States
HHSN261201000034C/PHS HHS/United States
HHSN261201000035C/PHS HHS/United States
HHSN261201000036C/PHS HHS/United States
HHSN261201000037C/PHS HHS/United States
HSN261201000032C/PHS HHS/United States
N01-PC-2010-0027/PC/NCI NIH HHS/United States
N01-PC-35137/PC/NCI NIH HHS/United States
N01-PC-35139/PC/NCI NIH HHS/United States
N01-PC-35142/PC/NCI NIH HHS/United States
N01-PC-35143/PC/NCI NIH HHS/United States
U58 DP000848-04/DP/NCCDPHP CDC HHS/United States
U58DP000832/DP/NCCDPHP CDC HHS/United States
U58DP0038789/DP/NCCDPHP CDC HHS/United States
Z99 CA999999/Intramural NIH HHS/United States
Description:BACKGROUND & AIMS
Studies of liver cancer risk in recipients of solid organ transplants have generally been small, yielding mixed results, and little is known about biliary tract cancers among transplant recipients.
We identified incident hepatobiliary cancers among 201,549 US recipients of solid organs, from 1987 through 2008, by linking data from the US transplant registry with 15 cancer registries. We calculated standardized incidence ratios (SIRs), comparing risk relative to the general population. We also calculated incidence rate ratios (RRs), comparing risk for hepatocellular carcinoma (HCC) and total (intrahepatic and extrahepatic) cholangiocarcinoma among subgroups of recipients.
Of transplant recipients, 165 developed hepatobiliary cancers (SIR, 1.2; 95% confidence interval [CI], 1.0–1.4). HCC risk was increased among liver recipients (SIR, 1.5; 95% CI, 1.0–2.2), especially 5 or more y after transplant (SIR, 1.8; 95% CI, 1.0–3.0). Cholangiocarcinoma was increased among liver (SIR, 2.9; 95% CI,1.6–4.8) and kidney recipients (SIR, 2.1; 95% CI, 1.3–3.1). HCC was associated with hepatitis B virus (RR, 3.2; 95% CI, 1.3–6.9), hepatitis C virus (RR, 10; 95% CI, 5.9–16.9), and non-insulin-dependent diabetes (RR, 2.5; 95% CI, 1.2–4.8). Cholangiocarcinoma was associated with azathioprine maintenance therapy (RR, 2.0; 95% CI, 1.1–3.7). Among liver recipients, primary sclerosing cholangitis (PSC) was associated with increased risk of cholangiocarcinoma, compared to the general population (SIR, 21; 95% CI, 8.2–42) and compared to liver recipients without PSC (RR, 12.3; 95% CI, 4.1–36.4).
Risks for liver and biliary tract cancer are increased among organ transplant recipients. Risk factors for these cancers include medical conditions and medications taken by recipients.
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