TY - JOUR
T1 - The risk of cancer in recipients of living-donor, standard and expanded criteria deceased donor kidney transplants: A registry analysis
AU - Ma, Maggie
AU - Lim, Wai
AU - Turner, Robin
AU - Chapman, Jeremy
AU - Craig, Jonathan
AU - Wong, Germaine
PY - 2014
Y1 - 2014
N2 - Background. Kidneys from expanded criteria deceased donors may elicit a strong inflammatory response, predisposing recipients to an increased risk of cancer after transplantation. We aimed to determine the association between donor types and cancer risk after kidney transplantation. Methods. Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed the association between different donor types (living donor, standard, and expanded criteria deceased donors) and the risk of cancer after kidney transplantation using adjusted Cox proportional hazard and competing risk models. Results. Over a median follow-up period of 4.4 years in 7,040 patients (34,684 patient-years), 468 patients (6.6%) developed cancer. The overall risks for cancer were 1,080, 1,444, and 2,018 per 100,000 patient-years for recipients of living donor, standard, and expanded criteria deceased donor kidneys, respectively. Compared to recipients of livingdonor kidneys, recipients of expanded criteria deceased donor kidneys were at an increased risk of cancer (adjusted hazard ratio [HR], 1.52; 95% confidence interval [95% CI], 1.15Y2.02; P=0.004), particularly for genitourinary cancer (adjusted HR, 1.79; 95% CI, 1.03Y3.10; P=0.038) and post-transplant lymphoproliferative disease (adjusted HR, 2.72; 95% CI, 1.38Y5.37; P=0.004). Conclusion. Recipients of expanded criteria deceased donor kidneys are at substantially increased risk of cancer, especially cancers with a viral etiology. Allocation of expanded criteria deceased donor kidneys to potential recipients should balance the harms, such as the excess risk of cancer against the survival gains and quality-of-life benefits associated with transplantation.
AB - Background. Kidneys from expanded criteria deceased donors may elicit a strong inflammatory response, predisposing recipients to an increased risk of cancer after transplantation. We aimed to determine the association between donor types and cancer risk after kidney transplantation. Methods. Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed the association between different donor types (living donor, standard, and expanded criteria deceased donors) and the risk of cancer after kidney transplantation using adjusted Cox proportional hazard and competing risk models. Results. Over a median follow-up period of 4.4 years in 7,040 patients (34,684 patient-years), 468 patients (6.6%) developed cancer. The overall risks for cancer were 1,080, 1,444, and 2,018 per 100,000 patient-years for recipients of living donor, standard, and expanded criteria deceased donor kidneys, respectively. Compared to recipients of livingdonor kidneys, recipients of expanded criteria deceased donor kidneys were at an increased risk of cancer (adjusted hazard ratio [HR], 1.52; 95% confidence interval [95% CI], 1.15Y2.02; P=0.004), particularly for genitourinary cancer (adjusted HR, 1.79; 95% CI, 1.03Y3.10; P=0.038) and post-transplant lymphoproliferative disease (adjusted HR, 2.72; 95% CI, 1.38Y5.37; P=0.004). Conclusion. Recipients of expanded criteria deceased donor kidneys are at substantially increased risk of cancer, especially cancers with a viral etiology. Allocation of expanded criteria deceased donor kidneys to potential recipients should balance the harms, such as the excess risk of cancer against the survival gains and quality-of-life benefits associated with transplantation.
KW - Cancer
KW - Deceased donor
KW - Donor
KW - Expanded criteria
KW - Kidney transplantation
UR - http://www.scopus.com/inward/record.url?scp=84925936355&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000000375
DO - 10.1097/TP.0000000000000375
M3 - Article
SN - 0041-1337
VL - 98
SP - 1286
EP - 1293
JO - Transplantation
JF - Transplantation
IS - 12
ER -