High Rate of Cancer-Related Death after Kidney Transplant

Kidney transplant recipients are at high risk of malignancy-related death, and this risk may be higher in recipients of organs from deceased donors, reports a study in Kidney International.

The researchers analyzed data on all kidney-only transplantations performed in England from 2001 to 2012, with linkage to hospital and mortality data. The study included 19,103 kidney transplant procedures, and the median follow-up time was 4.4 years. The analysis focused on the overall and site-specific risks of malignancy-related death, along with associated factors.

Of 2085 deaths during follow-up, 18 percent were malignancy-related, for a crude mortality rate of 361 deaths for 100,000 person-years. Lymphoma and lung cancer were the most common malignancies: 18.4 and 17.6 percent, respectively; followed by renal cancer, 9.8 percent; and unspecified cancers, 14.1 percent. Malignancy-related mortality was 0.8 percent for recipients younger than 50 years, 2.5 percent at ages 50 to 59, 4.8 percent at ages 60 to 69, 6.5 percent at ages 70 to 79, and 9.1 percent at age 80 or older.

When patients were stratified for age and sex, the risk of malignancy-related death was significantly higher in transplant recipients than in the general population. Independent risk factors included older age, history of cancer before transplantation, and receipt of organs from deceased donors.

Kidney transplant recipients are at increased risk of cancer, reflecting the effects of immunosuppression. Few data are available on the risk of malignancy-related mortality after transplantation.

The new results show that malignancy is a common cause of death after kidney transplantation. Although the increased risks associated with age and previous cancer history are expected, the link to deceased-donor organ transplantation is not. The findings underscore the importance of targeted surveillance after transplantation [Farrugia D, et al. Malignancy-related mortality following kidney transplantation is common. Kidney Int 2014; 85:1395–1403].