Kidney Week

Abstract: FR-PO1152

Cancer Incidence and Outcomes in Kidney Transplant Recipients with ANCA-Associated Vasculitis

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Arriola Montenegro, Jose J., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Jose J. Arriola Montenegro, MD

• Shams, Amir Hossein H., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Amir Hossein H. Shams, MD, MPH

• Herrera Hernandez, Loren Paola, Mayo Clinic Minnesota Department of Laboratory Medicine and Pathology, Rochester, Minnesota, United States

Loren Paola Herrera Hernandez, MD

• Fervenza, Fernando C., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Fernando C. Fervenza, MD, PhD, FASN

• Bentall, Andrew J., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Andrew J. Bentall, MD, MBChB, FASN

• Acuña, Pilar A., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Pilar A. Acuña, MD, RD

• Silva, Artur Quintiliano, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States

Artur Quintiliano Silva, MD

Background

Malignancy risk in patients with ANCA-associated vasculitis (AAV) remains incompletely defined, particularly in the transplant setting. We examined cancer incidence in kidney transplant recipients (KTR) with AAV.

Methods

Retrospective study of 81 KTR with AAV at Mayo Clinic (1983–2024). Clinical and transplant data were collected; associations with post-transplant malignancy and survival outcomes were analyzed.

Results

The cohort had high comorbidity burden, with 61.7% extra-renal involvement, low immunologic risk (median cPRA 0% [IQR 0–27]), and 6.2% re-transplantation. Induction therapy was used in 88.9%, and 79% received triple immunosuppression (tacrolimus, prednisone, mycophenolate). One-year rejection occurred in 23.5% (84.2% cellular). Overall, 35.8% developed cancer, most commonly non-melanoma skin (27.6%), melanoma (20.7%), and urothelial (17.8%), with median onset at 60 months (IQR 26–96). Male sex was independently associated with malignancy (OR 6.08; HR 2.82). Thymoglobulin showed a reduced cancer risk signal on time-to-event analysis (HR 0.31), not confirmed in bivariable analysis. AAV therapy and pre-transplant dialysis were not associated with malignancy. At 5 and 10 years, patient survival was 70.4% and 46.9%, graft survival 90% and 77%, and death-censored graft survival 70.4% and 41.5%. Malignancy was not associated with patient or graft survival, and outcomes did not differ by cancer type.

Conclusion

Malignancy is common among KTR with AAV, affecting over one-third of patients. Male sex predicts higher risk, identifying a subgroup for enhanced screening.Despite this burden, graft survival remained relatively preserved, suggesting mortality may be driven by non-graft-related factors. Findings support sex-informed cancer surveillance in AAV transplant recipients.

(A) patient survival, (B) graft survival. (C) death-censored graft survival.