De-novo malignancies after kidney transplantation: A long-term observational study

• Published in: PloS one 2020-11, Vol.15 (11), p.e0242805
• Main Authors: Fröhlich, Felix A, Halleck, Fabian, Lehner, Lukas, Schrezenmeier, Eva V, Naik, Marcel, Schmidt, Danilo, Khadzhynov, Dmytro, Kast, Katharina, Budde, Klemens, Staeck, Oliver
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Blood & organ donations; Cancer; Cancer screening; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - epidemiology; Carcinoma, Renal Cell - etiology; Carcinoma, Renal Cell - pathology; Complications and side effects; Diagnosis; Dialysis; Female; Gastrointestinal cancer; Gastrointestinal system; Hematology; Humans; Immunoproliferative diseases; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Intensive care; Intestine; Kidney cancer; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Liver Transplantation - adverse effects; Longitudinal Studies; Lymphocytes; Lymphoproliferative Disorders - diagnosis; Lymphoproliferative Disorders - epidemiology; Lymphoproliferative Disorders - etiology; Lymphoproliferative Disorders - pathology; Male; Malignancy; Medical diagnosis; Medicine and Health Sciences; Melanoma; Middle Aged; Mortality; Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - etiology; Neoplasms - pathology; Nephrology; Observational studies; Patient outcomes; Patients; Posttransplant lymphoproliferative disorders; Prostate; Prostate cancer; Renal cell carcinoma; Reproductive system; Respiratory system; Retrospective Studies; Skin cancer; Skin diseases; Transplants & implants; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242805

De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies. 1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation. De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.