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Kidney Week

Abstract: SA-PO208

Calendar Trends in Cancer Incidence Among US Kidney Transplant Recipients

Session Information

  • Onco-Nephrology: Clinical
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Blosser, Christopher D., University of Washington, Seattle, Washington, United States
  • Haber, Gregory, National Cancer Institute, Bethesda, Maryland, United States
  • Engels, Eric A., National Cancer Institute, Bethesda, Maryland, United States
Background

Kidney transplant recipients (KTRs) are at 2-4 times greater risk of cancer compared with the general population, and older recipients are at highest risk. Kidney allograft survival is improving with newer immunosuppression and allocation policies. We assessed the changes in incidence of cancers after kidney transplant over time.

Methods

We compared the incidence of cancer in first time kidney-only transplant recipients within three ten-year calendar intervals (1987-1996, 1997-2006, 2007-2016) characterized through linkage of SRTR and cancer registry databases from 17 U.S. states and regions in the Transplant Cancer Match Study. KTRs were excluded for a cancer diagnosis before or within 90 days post-transplant, if transplanted before cancer registry coverage, or HIV infection. First cancers were identified from cancer registries if <5 years of transplant. We analyzed overall cancer and post-transplant cancers: colorectal, lung, melanoma, breast, prostate, kidney, and non-Hodgkin lymphoma (NHL). Non-melanoma skin cancer is not reported to cancer registries. Poisson regression was used to compare incidence rate ratios (IRR) across time intervals among KTRs with the earliest era as the reference, and adjusted for risk factors including age at transplant, gender, primary cause of ESRD, time on transplant waiting list, BMI, type of kidney donor, and maintenance immunosuppression.

Results

The KTR population increased in age over the three decades - mean age 44.3, 48.6, and 50.9 years, respectively. Unadjusted IRR of overall cancer in KTRs appeared to increase over this period, but IRRs decreased after adjusting for age and other variables; Differences across decades were not significant. Adjusted IRRs for most common post-transplant cancers decreased nonsignificantly over time, except for kidney cancer, which appeared to increase.

Conclusion

Overall cancer incidence has trended downward amidst an older KTR population in the last three decades. Kidney cancer incidence may have risen over time while all other common cancer IRRs were stable or lower. The reasons for the age-adjusted decline over time may include better cancer screening, tighter transplant listing criteria, and changes in immunosuppression.

Funding

  • Other NIH Support