Spectrum of Cancer Risk among U.S. Solid Organ Transplant Recipients: The Transplant Cancer Match Study
Published Date:Nov 2 2011
Pubmed Central ID:PMC3310893
Funding:15-0351/PHS HHS/United States
1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
5658DP000805-04/DP/NCCDPHP CDC HHS/United States
5U58/DP000808-03/DP/NCCDPHP CDC HHS/United States
5U58DP000812-03/DP/NCCDPHP CDC HHS/United States
5U58DP000817-05/DP/NCCDPHP CDC HHS/United States
5U58DP000824-04/DP/NCCDPHP CDC HHS/United States
HHSH234200537009C/PHS HHS/United States
HHSH250201000018C/PHS HHS/United States
HHSN261200544005C/PHS HHS/United States
HHSN261201000024C/PHS HHS/United States
HHSN261201000034C/PHS HHS/United States
HHSN261201000035C/PHS HHS/United States
HHSN261201000036C/PHS HHS/United States
HHSN261201000037C/PHS 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
N01-PC-54405/PC/NCI NIH HHS/United States
U58 DP000848-04/DP/NCCDPHP CDC HHS/United States
U58DP000832/DP/NCCDPHP CDC HHS/United States
ZIA CP010150-10/Intramural NIH HHS/United States
Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Since most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology.
Describe the overall pattern of cancer among solid organ transplant recipients.
Cohort study using linked data from the U.S. Scientific Registry of Transplant Recipients (1987–2008) and 13 state/regional cancer registries.
Participants and Setting
Solid organ transplant recipients in the U.S.
Main Outcome Measure
Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared to the general population.
Registry linkages yielded data on 175,732 solid organ transplants (58.4% kidney, 21.6% liver, 10.0% heart, 4.0% lung). Overall cancer risk was elevated (N=10,656 cases, incidence 1374.7 per 100,000 person-years; SIR 2.10, 95%CI 2.06–2.14; EAR 719.3, 95%CI 693.3–745.6, per 100,000 person-years). Risk was increased (p<0.001) for 32 different malignancies, some related to known infections (e.g., anal cancer, Kaposi sarcoma) and others unrelated (e.g., melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (N=1504, incidence 194.0; SIR 7.54, 95%CI 7.17–7.93; EAR 168.3, 95%CI 158.6–178.4) and cancers of the lung (N=1344, incidence 173.4; SIR 1.97, 95%CI 1.86–2.08; EAR 85.3, 95%CI 76.2–94.8), liver (N=930, incidence 120.0; SIR 11.56, 95%CI 10.83–12.33; EAR 109.6, 95%CI 102.0–117.6), and kidney (N=752, incidence 97.0; SIR 4.65, 95%CI 4.32–4.99; EAR 76.1, 95%CI 69.3–83.3). Lung cancer risk was most elevated in lung recipients (SIR 6.13, 95%CI 5.18–7.21) but also increased among other recipients (SIR 1.46, 95%CI 1.34–1.59 for kidney; 1.95, 1.74–2.19 for liver; 2.67, 2.40–2.95 for heart). Liver cancer was elevated only among liver recipients (SIR 43.83, 95%CI 40.90–46.91), who manifested exceptional risk in the first 6 months (SIR 508.97, 95%CI 474.16–545.66) and continuing two-fold excess for 10–15 years (SIR 2.22, 95%CI 1.57–3.04). Among kidney recipients, kidney cancer was elevated (SIR 6.66, 95%CI 6.12–7.23) and bimodal in onset. Kidney cancer was also increased in liver and heart recipients (SIR 1.80, 95%CI 1.40–2.29, and 2.90, 2.32–3.59, respectively).
Recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers, compared with the general population.
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