Cumulative incidence of cancer after solid organ transplantation

Abstract

Background: Solid organ transplantation recipients have elevated cancer incidence. Estimates of absolute cancer risk after transplantation can inform prevention and screening.

Methods: The Transplant Cancer Match Study links the US transplantation registry with 14 state/regional cancer registries. The authors used nonparametric competing risk methods to estimate the cumulative incidence of cancer after transplantation for 2 periods (1987-1999 and 2000-2008). For recipients from 2000 to 2008, the 5-year cumulative incidence, stratified by organ, sex, and age at transplantation, was estimated for 6 preventable or screen-detectable cancers. For comparison, the 5-year cumulative incidence was calculated for the same cancers in the general population at representative ages using Surveillance, Epidemiology, and End Results data.

Results: Among 164,156 recipients, 8520 incident cancers were identified. The absolute cancer risk was slightly higher for recipients during the period from 2000 to 2008 than during the period from 1987 to 1999 (5-year cumulative incidence: 4.4% vs. 4.2%; P = .006); this difference arose from the decreasing risk of competing events (5-year cumulative incidence of death, graft failure, or retransplantation: 26.6% vs. 31.9%; P < .001). From 2000 to 2008, the 5-year cumulative incidence of non-Hodgkin lymphoma was highest at extremes of age, especially in thoracic organ recipients (ages 0-34 years: range, 1.74%-3.28%; aged >50 years; range, 0.36%-2.22%). For recipients aged >50 years, the 5-year cumulative incidence was higher for colorectal cancer (range, 0.33%-1.94%) than for the general population at the recommended screening age (aged 50 years: range, 0.25%-0.33%). For recipients aged >50 years, the 5-year cumulative incidence was high for lung cancer among thoracic organ recipients (range, 1.16%-3.87%) and for kidney cancer among kidney recipients (range, 0.53%-0.84%). The 5-year cumulative incidence for prostate cancer and breast cancer was similar or lower in transplantation recipients than at the recommended ages of screening in the general population.

Conclusions: Subgroups of transplantation recipients have a high absolute risk of some cancers and may benefit from targeted prevention or screening.

Figure 1

The cumulative incidence of cancer and of death, graft failure, or retransplantation among US solid organ transplantation recipients is illustrated. Curves indicate the cumulative incidence of (A) all incident cancers and (B) the competing events of death, graft failure, or retransplantation after kidney, liver, heart, or lung transplantation. Results are provided separately for 2 eras defined by calendar year of transplantation. The vertical axis indicates the percentage of recipients with the specified outcome; the scales differ in A and B.

Figure 2

The 5-year cumulative incidence of (A) non-Hodgkin lymphoma and (B) lung cancer are illustrated after transplantation and for the US population from 2000 to 2008. Results correspond to the probability that individuals will develop the specified cancer over a 5-year period. Estimates for recipients are limited to patients who underwent transplantation during 2000 to 2008 and are stratified by transplanted organ, sex, and age at transplantation. Estimates of cumulative incidence for the US population were derived from Surveillance, Epidemiology, and End Results (SEER) Program data.

Figure 3

The 5-year cumulative incidence of (A) colorectal cancer and (B) kidney cancer is illustrated after transplantation and for the US population from 2000 to 2008. Estimates for recipients are limited to patients who underwent transplantation during 2000 to 2008 and are stratified by transplanted organ, sex, and age at transplantation. Results correspond to the probability that individuals will develop the specified cancer over a 5-year period. Estimates of cumulative incidence for the US population were derived from Surveillance, Epidemiology, and End Results (SEER) Program data. Scales differ in A and B.

Figure 4

The 5-year cumulative incidence of (A) prostate cancer and (B) breast cancer is illustrated after transplantation and for the US population from 2000 to 2008. Estimates for recipients are limited to patients who underwent transplantation during 2000 to 2008 and are stratified by transplanted organ and age at transplantation. Results correspond to the probability that individuals will develop the specified cancer over a 5-year period. Estimates of cumulative incidence for the US population were derived from Surveillance, Epidemiology, and End Results (SEER) Program data. Scales differ in A and B.