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Abstract: FR-PO809

Malignancy Risk in Kidney Transplant Recipients Exposed to Immunosuppression Pre-Transplant for the Treatment of Glomerulonephritis

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Massicotte-Azarniouch, David, University of Ottawa, Ottawa, Ontario, Canada
  • Detwiler, Randal K., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Hu, Yichun, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Falk, Ronald, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Saha, Manish K., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., University of North Carolina System, Chapel Hill, North Carolina, United States
Background

Kidney transplant patients with glomerulonephritis (GN) as their native disease may be exposed to significant amounts of pre-transplant immunosuppression (PTI), which could increase the risk for the development of malignancy post-transplant.

Methods

We conducted a single-center, retrospective study of adult and pediatric kidney transplant recipients at University of North Carolina Hospitals from January 2005 until May 2020. Patients with GN as their native kidney disease who received PTI for the treatment of GN (n=184) were compared to a control cohort (n=579) of non-diabetic, non-PTI receiving kidney transplant patients. We calculated hazard ratios (HR) with 95% confidence intervals (95%CI) for the outcomes of the first occurrence of solid or hematologic malignancy, non-melanoma skin cancer (NMSC) and post-transplant lymphoproliferative disorder (PTLD).

Results

Over a median follow-up of 5.7 years, PTI for GN was associated with significantly increased risk for malignancy compared to controls (13.0% vs 9.7% respectively, adjusted HR 1.82 [95%CI 1.10-3.00]), but not for NMSC (10.3% vs 11.4% respectively, adjusted HR 1.09 [95%CI 0.64-1.83]) nor PTLD (3.3% vs 3.1% respectively, adjusted HR 1.02 [95%CI 0.40-2.61]). The risk for malignancy was significantly increased in those who received cyclophosphamide (HR 2.59 [95%CI 1.48-4.55]) or rituximab (HR 3.82 [95%CI 1.69-8.65]) pre-transplant, and particularly in those who received both cyclophosphamide and rituximab, but not for calcineurin inhibitors nor mycophenolate.

Conclusion

The use of PTI for treatment of GN, in particular cyclophosphamide or rituximab, is associated with increased risk for development of solid or hematologic malignancy post-transplant.