Post Kidney Transplant Cancer

Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Non-function Intervals

Elizabeth L. Yanik, Christina A. Clarke, Jon J. Snyder, Ruth M. Pfeiffer and Eric A. Engels JASN May 2016, 27 (5) 1495-1504; DOI: https://doi.org/10.1681/ASN.2015040373

Among patients with End Stage Renal Disease (ESRD), cancer risk is affected by kidney dysfunction and by immunosuppression after transplant.

Assessing patterns across periods of dialysis and kidney transplantation may inform cancer etiology.

We evaluated 202,195 kidney transplant candidates and recipients from a linkage between the Scientific Registry of Transplant Recipients and cancer registries, and compared
-incidence in kidney function intervals (time with a transplant) with
-incidence in nonfunction intervals (waitlist or time after transplant failure), adjusting for demographic factors.

Incidence of infection-related and immune-related cancer was higher during kidney function intervals than during nonfunction intervals.

Incidence with 95% confidence interval
-Kaposi sarcoma (HR, 9.1) range 4.7 to 18,
-Non-Hodgkin’s lymphoma (HR, 3.2) range 2.8 to 3.7,
-Hodgkin’s lymphoma (HR, 3.0) range 1.7 to 5.3,
-lip cancer (HR, 3.4) range 2.0 to 6.0, and
-nonepithelial skin cancers (HR, 3.8) range 2.5 to 5.8).

Conversely, ESRD-related cancer incidence was lower during kidney function intervals

-kidney cancer: HR, 0.8; range 0.7 to 0.8
-thyroid cancer: HR, 0.7; range 0.6 to 0.8

With each successive interval, incidence changed in alternating directions for
-non-Hodgkin’s lymphoma,
-melanoma,
-lung,
-pancreatic, and
-nonepithelial skin cancers (higher during function intervals), and
-kidney and thyroid cancers (higher during nonfunction intervals).

For many cancers, incidence remained higher than in the general population across all intervals. These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention.

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