Spectrum of Cancer Risk among U.S. Solid Organ Transplant Recipients: The Transplant Cancer Match Study

Details

• Alternative Title:
  JAMA
• Personal Author:
  Engels, Eric A. ; Pfeiffer, Ruth M. ; Fraumeni, Joseph F. ; Kasiske, Bertram L. ; Israni, Ajay K. ; Snyder, Jon J. ; Wolfe, Robert A. ; Goodrich, Nathan P. ; Bayakly, A. Rana ; Clarke, Christina A. ; Copeland, Glenn ; Finch, Jack L. ; Fleissner, Mary Lou ; Goodman, Marc T. ; Kahn, Amy ; Koch, Lori ; Lynch, Charles F. ; Madeleine, Margaret M. ; Pawlish, Karen ; Rao, Chandrika ; Williams, Melanie A. ; Castenson, David ; Curry, Michael ; Parsons, Ruth ; Fant, Gregory ; Lin, Monica
• Description:
  Context
  
  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.
  
  Objective
  
  Describe the overall pattern of cancer among solid organ transplant recipients.
  
  Design
  
  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.
  
  Results
  
  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).
  
  Conclusions
  
  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.
  
  
• Subjects:
  Adolescent Adult Aged Child Child, Preschool Cohort Studies Female Humans Immune Tolerance Immunocompromised Host Incidence Infant Male Middle Aged Neoplasms Organ Transplantation Registries Risk Young Adult

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• Source:
  JAMA. 306(17):1891-1901.
• Pubmed ID:
  22045767
• Pubmed Central ID:
  PMC3310893
• Document Type:
  Journal Article
• 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
• Place as Subject:
  United States
• Volume:
  306
• Issue:
  17
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9c055c6c9e2fd8d4976b56c187af2cece8ceea852b411b4f4f15d8eb61aefe89
• Download URL:
  https://stacks.cdc.gov/view/cdc/33328/cdc_33328_DS1.pdf
• File Type:
  [PDF - 522.57 KB ]