Abstract: SA-PO518
Non Melanoma Skin Cancer Risk Following Graft Failure in Renal Transplant Recipients in Ireland, 1994-2015: Does the Hazard Vary during Periods of Dialysis?
Session Information
- Immunosuppression, Disease Recurrence, and Malignancy
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Sexton, Donal J., The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin., Dublin, Ireland
- O'kelly, Patrick, Beaumont Hospital, Dublin, Ireland
- Deady, Sandra, National Cancer Registry, Ireland, Cork, Ireland
- Conlon, Peter J., Beaumont Hospital, Dublin 9, Co Dublin, Ireland
Background
Non melanoma skin cancer (NMSC) is common after renal transplant. Whether the risk of skin cancer development varies as treatment for ESKD varies is not well described. We evaluated whether this risk is attenuated during periods of graft loss with a return to dialysis.
Methods
The National Kidney Transplant Service (NKTS) database was accessed for the years 1994-2015 and all recipients with available data were included in the analysis. This data was linked with the national Irish Cancer Registry (NCRI) to capture episodes of malignancy over follow up. In our analysis we considered end stage kidney disease (ESKD) treatment modality as a time varying covariate and calculated incidence rates, which may fluctuate between transplant and dialysis over follow up. Limitations include: difficulty in capturing the lag between exposure and diagnosis, which may vary by treatment period.
Results
3,672 deceased and living donor adult kidney transplants were assessed comprising 2,310 (62.9%) male and 1,362 (37.1%) female recipients. Periods of treatment with functioning transplant had a higher incidence of skin cancer diagnosis [adjusted incidence rate ratio IRR 2.41 (1.72, 3.38),P<0.001]. Other risk factors for skin cancer included male sex, the number of transplants, and episodes of acute rejection. Tacrolimus was associated with a lower risk compared to cyclosporin however this may be due to a period effect, with longer follow up and ascertainment with ciclosporin.
Conclusion
The incidence of skin cancer was higher during periods defined by a functioning renal transplant and lower during subsequent periods of dialysis following graft failure. It is likely that periods defined by graft failure lead to lower overall immunosuppressive burden over follow up.
Non-Melanoma skin cancer incidence with ESKD treatment modality as a time-varying covariate.