ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2125

Immunosuppression and Incident Cancer Risk in Older Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Caliskan, Yasar, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Li, Ruixin, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Schnitzler, Mark, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
  • Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States
  • Ahn, JiYoon B., Johns Hopkins University, Baltimore, Maryland, United States
  • Bunnapradist, Suphamai, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Bae, Sunjae, Johns Hopkins University, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Hess, Gregory, Drexel University, Philadelphia, Pennsylvania, United States
  • Axelrod, David, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
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, 0.600.760.96). IL2rAb+steroid avoidance was associated with increased non-viral driven/non-skin cancer (aHR, 1.031.341.75), while CsA-based ISx predicted lower risk (aHR 0.590.750.95) (Fig. B). However, adjusted for time-varying impact of viral-driven (aHR 1.992.272.58) and non-viral driven/non-skin cancers (aHR 2.112.272.43), CsA use (aHR 1.121.241.37) 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