Kidney Week

Abstract: PO2125

Immunosuppression and Incident Cancer Risk in Older Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN

• Caliskan, Yasar, Saint Louis University School of Medicine, Saint Louis, Missouri, United States

Yasar Caliskan,

• Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Wisit Cheungpasitporn,

• Li, Ruixin, Saint Louis University School of Medicine, Saint Louis, Missouri, United States

Ruixin Li,

• Schnitzler, Mark, Saint Louis University School of Medicine, Saint Louis, Missouri, United States

Mark Schnitzler,

• McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

• Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Ahn, JiYoon B., Johns Hopkins University, Baltimore, Maryland, United States

JiYoon B. Ahn,

• Bunnapradist, Suphamai, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Suphamai Bunnapradist,

• Bae, Sunjae, Johns Hopkins University, Baltimore, Maryland, United States

Sunjae Bae,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Hess, Gregory, Drexel University, Philadelphia, Pennsylvania, United States

Gregory Hess,

• Axelrod, David, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States

David Axelrod,

Background

Cancer is a serious complication after kidney transplant (KTx), especially among older adults. The relationship of immunosuppression (ISx) to cancer in older KTx recipients is not well described.

Methods

We examined USRDS data (2005-2017) to explore associations of ISx regimens (within 6 mo) with new-onset cancer diagnoses >6 mo-to-5 yr post-KTx among Medicare-insured older (aged ≥ 65) adults. We used multivariate Cox regression with inverse propensity weighting to compare cancer risk vs. reference regimen of Thymoglobulin (TMG) or Alemtuzumab (ALEM) + Tacrolimus + antimetabolite + prednisone. Cancer diagnoses were also examined as time-dependent mortality predictors.

Results

Among 12567 older recipients, skin cancer incidence was higher with Tac+antimetabolite avoidance (10.3%) and CsA-based ISx (8.9%) compared to TMG/ALEM+triple ISx (6.4%; P=0.03 and P=0.002), while non-viral driven/non-skin cancer was less common with CsA-based ISx (10.9% vs 14.7%; P=0.03) (Fig. A). In adjusted models, IL2rAb+triple ISx was associated with lower skin cancer risk (aHR, _0.600.76_0.96). IL2rAb+steroid avoidance was associated with increased non-viral driven/non-skin cancer (aHR, _1.031.34_1.75), while CsA-based ISx predicted lower risk (aHR _0.590.75_0.95) (Fig. B). However, adjusted for time-varying impact of viral-driven (aHR _1.992.27_2.58) and non-viral driven/non-skin cancers (aHR _2.112.27_2.43), CsA use (aHR _1.121.24_1.37) predicted increased mortality in older recipients.

Conclusion

Although CsA-based ISx appears beneficial for non-skin cancer risk in older KTx recipients, this regimen is associated with increased mortality. Cancer risk is a consideration in tailoring ISx in older KTx recipients.

Funding

• NIDDK Support