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2017 ; 8
(44
): 77771-77782
Nephropedia Template TP
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Long-term allograft and patient outcomes of kidney transplant recipients with and
without incident cancer - a population cohort study
#MMPMID29100424
Lim WH
; Badve SV
; Wong G
Oncotarget
2017[Sep]; 8
(44
): 77771-77782
PMID29100424
show ga
The excess risk for cancer in kidney transplant recipients is substantial, but
the allograft and patient survivals after cancer development are under-studied.
This is a population-based cohort study of all primary live and deceased donor
kidney transplant recipients in Australia and New Zealand between 1990-2012. The
risks of overall graft loss and death with a functioning graft in kidney
transplant recipients with and without incident cancer were determined using
adjusted Cox regression analysis, with incident cancer considered as a
time-varying covariate in the models. In those with incident cancer, types and
cancer stage at diagnoses were reported. Of 12,545 transplant recipients followed
for a median of 6.9 years (91,380 patient-years), 1184 (9.4%) developed incident
cancers at a median of 5.8 years post-transplant. Digestive, kidney and urinary
tract cancers were the most common cancer types, although digestive and
respiratory tract cancers were more aggressive, with 40% reported as advanced
cancers at time of cancer diagnosis. Cancer-related deaths accounted for
approximately 80% of recipients with a prior cancer history. Compared with
recipients with no prior cancer, the adjusted hazard ratios (HR) for overall
graft loss and death with functioning graft were 4.34 (95%CI 3.90, 4.82; p<0.001)
and 9.53 (95%CI 8.30, 10.95; <0.001) among those with a prior cancer. Incident
cancer after kidney transplantation is a significant risk factor for death with a
functioning graft, with the majority of deaths attributed to cancer. A greater
understanding of the barriers to screening and treatment approaches following
cancer diagnosis may lead to improve survival in kidney transplant recipients
with cancer.