Abstract: TH-PO1032
Post-Transplant Malignancy Drives Mortality-Related Outcomes but Not Death-Censored Graft Failure After Kidney Transplantation: A Nationwide Competing Risk Analysis
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Lee, Jinsun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Kim, Minsang, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Song, Jeongin, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea (the Republic of)
- Kang, Eunjeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Background
Post-transplant malignancy (PTM) is a major long-term complication after kidney transplantation (KT), yet its differential impact on patient survival and intrinsic graft failure remains unclear. We aimed to evaluate the association of PTM with all-cause mortality, death with a functioning graft (DWFG), and death-censored graft failure (DCGF) in a nationwide KT cohort.
Methods
Using the Korean National Health Insurance Service database, we identified adults aged ≥20 years who underwent KT between 2007 and 2023. PTM was modeled as a time-dependent exposure. Multivariable Cox regression assessed all-cause mortality, while cause-specific Cox models assessed DCGF and DWFG under competing risks. Landmark analyses were performed at 1, 3, and 5 years after KT. Standardized mortality ratios (SMRs) versus the general population were calculated overall and by age, sex, and cancer subtype. Interaction-tested subgroup analyses were performed.
Results
Among 21,776 KT recipients, 1,898 developed PTM during a median follow-up of 6.6 years. PTM was associated with higher all-cause mortality (aHR 4.41, 95% CI 3.69–5.28) and DWFG (aHR 4.90, 95% CI 4.04–5.95), but not DCGF (aHR 1.03, 95% CI 0.73–1.46; p=0.861). This mortality-dominant, DCGF-sparing dissociation persisted in landmark analyses at 1, 3, and 5 years after KT. Excess mortality was higher in PTM than non-PTM recipients overall (SMR 10.37 vs. 5.73; P<0.001), especially among women and recipients aged 30–39 years. Cancer subtype–specific excess mortality was highest for central nervous system and head and neck cancers. Stronger PTM–mortality associations were observed in younger, desensitized, and shorter pre-KT dialysis recipients.
Conclusion
In this nationwide cohort, PTM imposed a substantial and selective mortality burden while sparing DCGF. This suggests that PTM primarily compromises patient survival before intrinsic allograft failure becomes apparent, supporting survival-first strategies, including cancer subtype–specific surveillance and risk-stratified counseling.
Acknowledgment
None.
Funding
- Clinical Revenue Support